Unsafe abortion accounts for 35% of maternal mortality in Kenya. Post-abortion care (PAC) reduces maternal death and provides an opportunity to prevent unwanted pregnancies. Few studies have documented how the receipt of PAC services varies by client age. In this study, descriptive data were collected from clients, providers and eight health facilities in Kenya's Central and Nairobi provinces to examine receipt of PAC services by client age, client satisfaction and provider attitudes. Delivery of PAC treatment, pain management, HIV and STI services and violence screening did not vary by age. However, fewer youth between the ages of 15 and 24 received a contraceptive method compared with adult clients (35% versus 48%; p=0.02). Forty-nine per cent of youth reported not using a family planning method due to fears of infertility, side-effects or lack of knowledge compared with 22% of adults. Additional efforts are needed in Kenya to bolster the family planning services that young PAC clients receive and increase the uptake of contraception.

This study aimed to assess whether teaching good cooking practices, food habits and sanitation to ultra-poor rural women in four rural communities of Rangpur district, Bangladesh, with a high density of extremely poor households, would improve the overall health of the community. The sample size was 200 respondents combined from the target and control areas. In the target area, twelve in-depth interviews and four focus group discussions were undertaken for knowledge dissemination. Descriptive and mixed-model analyses were performed. The results show that washing hands with soap was 1.35 times more likely in the target than the control group (p<0.01). Further, after intervention, there was a significant improvement in hand-washing behaviour: before cutting vegetables, preparing food, feeding a child and eating, and after defecating and cleaning a baby (p<0.05). Also, the target group was more likely to moderately and briefly boil their vegetables and were 19% less likely to use maximum heat when cooking vegetables than the control group (p<0.01). Improved knowledge and skills training of ultra-poor women reduces the loss of nutrients during food preparation and increases their hygiene through hand-washing in every-day life.

This study explored the association of socioeconomic status with individuals' perception of their body image (BI) and body weight (BW) among adults in a sub-urban Nigerian population. The cross-sectional sample comprised 1521 residents (775 males and 746 females) of the town of Nnewi. Perceived BI was assessed using figural representations of different sizes for males and females. Perceived BW was determined by presenting participants with BW category options to choose from. Body mass index (BMI) was calculated from objectively measured BW and height using standardized procedures. Actual BW categories were derived from participants' BMIs using WHO criteria. Perceived BI and BW differed from actual BW among unskilled and non-tertiary males (p<0.001) and female (p<0.001 to p<0.04) in all BW categories whereas these variables differed (p<0.001) among skilled and tertiary males and females in normal weight, overweight and obese categories. Perceived BW differed (p<0.001) from actual BW among unskilled and non-tertiary males in underweight, overweight and obese categories whereas these variables differed (p<0.001) among unskilled and non-tertiary females, skilled and tertiary males and females in overweight and obese categories. Underweight ‘unskilled’ and ‘non-tertiary’ males perceived their BI to be different from their actual BW (p<0.001). Overweight and obese ‘skilled’ and ‘unskilled’, and ‘tertiary’ and ‘non-tertiary’, males and females perceived their BI and BW to be different from their actual BW (p<0.001). Significant differences in perceived BI existed between ‘skilled’ and ‘unskilled’ (p<0.001), and ‘tertiary’ and ‘non-tertiary’ (p=0.005), overweight males, and between ‘skilled’ and ‘unskilled’ (p<0.001), and ‘tertiary’ and ‘non-tertiary’ (p=0.008), normal-weight females. The ‘skilled’ participants had a lower risk of perceiving a larger BI (OR 0.51, 95% CI 0.41–0.64; p<0.001) and larger BW (OR 0.71, 95% CI 0.53–0.96; p=0.03) than the ‘unskilled’ participants. The ‘tertiary’ participants had a lower risk of perceiving a larger BI (OR 0.51, 95% CI 0.40–0.63; p<0.001) and larger BW (OR 0.71, 95% CI 0.53–0.95; p=0.02) than the ‘non-tertiary’ participants. After adjusting for possible confounders, all the risks became insignificant except for perception of BI by the ‘skilled’ participants (OR 0.70, 95% CI 0.50–0.99; p=0.04). Individuals in the different occupational and educational categories perceived their BI differently but their BW similarly. Given the same BMI, age, perceived ideal BI and sex, only occupation is found to be associated with perception of BI.

Chinese youth represent a high-risk group for sexually transmitted infections and unintended pregnancies, but there is little understanding of their sexual behaviours. Using nationally representative data, this study examines the social and demographic correlates of condom use by Chinese youth at sexual debut. It also examines the relationship context of condom use at sexual debut. The results indicate that condom use at sexual debut is very low in China, confirming that youth are a high-risk group. The results demonstrate that age and educational attainment are the primary indicators of condom use. Early sexual debut associates with a greater risk of unsafe sex at sexual debut and higher educational attainment increases the likelihood of self-protecting behaviours. The likelihood of self-protection also increases when sexual partners plan their sexual debut or discuss contraception beforehand. The results suggest that interventions are needed to provide youth with better knowledge about self-protection.

Studies consistently show that increasing levels of socioeconomic status (SES) and having a familial history of longevity reduce the risk of mortality. But do these two variables interact, such that individuals with lower levels of SES, for example, may experience an attenuated longevity penalty by virtue of having long-lived relatives? This article examines this interaction by analysing survival past age 40 based on data from the Utah Population Database on an extinct cohort of men born from the years 1840 to 1909. Cox proportional hazards regression and logistic regression are used to test for the main and interaction mortality effects of SES and familial excess longevity (FEL), a summary measure of an individual's history of longevity among his or her relatives. This research finds that the mortality hazard rate for men in the top 15th percentile of occupational status decreases more as FEL increases than it does among men in the bottom 15th percentile. In addition, the mortality hazard rate among farmers decreases more as FEL increases than it does for non-farmers. With a strong family history of longevity as a proxy for a genetic predisposition, this research suggests that a gene–environment interaction occurs whereby the benefits of familial excess longevity are more available to those who have occupations with more autonomy and greater economic resources and/or opportunities for physical activity.

This paper reports the development of a short scale (ten items) entitled ‘Social Relationships to Prevent Obesity’ (SRPO), which examines how social relationships support the continuous and conscious endeavour to lose weight. The construct and criterion validity of this scale were ascertained in this study. Factor structure and reliability were examined using data from a randomized controlled trial. A confirmatory factor analysis of the SRPO revealed three relevant factors. The results suggest that the SRPO has both validity and clinical utility and can thus be used as a screening tool in weight-loss interventions and to assess the degree of, and trends in, self-control for weight loss in individuals. The scale can also be used to examine the environmental and self-control problems faced by obese people – factors that should be considered when conducting weight-loss interventions.

Ethnicity has been found to be a significant indicator of social position, and many studies have also established that ethnicity is a significant determinant of contraceptive use. This study aims to examine whether ethnicity is an important predictor of unmet need for contraception. Analysis was based on data for 4343 ever-married women drawn from the 2007 Zambia Demographic and Health Survey. Descriptive analysis indicates that in all ethnic groups except the Barotse and Tonga, women aged 15–49 years were married at an average age below 18. The highest mean number of children among the ethnic groups was 6.7, among the Bemba; the lowest was 5.9, among the Barotse. The highest proportion of women with an unmet need for contraception resided in the Eastern region. Multivariate logistic analyses reveal that children ever-born and region of residence were the most important predictors of unmet need for spacing, whereas for unmet need for limiting predictors were age at first marriage and partner's desire for children. Moreover, unmet need for spacing and limiting among women with secondary or higher education was significantly lower (47% and 50%, respectively) compared with those with no education. Ethnicity was not a significant predictor of unmet need for contraception. The findings stress the need for programmes aimed at enhancing the socioeconomic status of women.

This study examined the association of gender-based attitudes, HIV misconceptions and community feelings for marginalized groups with stigmatizing responses towards people with HIV/AIDS in Mumbai, India. Participants included 546 men and women sampled in hospital settings during 2007–2008. Structured measures were used to assess avoidance intentions and denial of rights of people with HIV/AIDS. Mean age of participants was 32 years; 42% had less than 10 years of education. Higher HIV transmission misconceptions (β=0.47; p<0.001), more traditional gender attitudes (β=0.11; p<0.01) and more negative feelings towards HIV-positive people (β=0.23; p<0.001) were related to higher avoidance intentions. Endorsement of denial of rights was also significantly associated with higher transmission misconceptions (β=0.20; p<0.001), more traditional gender attitudes (β=0.33; p<0.001) and greater negative feelings towards HIV-positive people (β=0.12; p<0.05), as well as with a lower education level (β=−0.10; p<0.05). The feelings respondents had towards people with HIV/AIDS were more strongly correlated with their feelings towards those with other diseases (tuberculosis, leprosy) than with feelings they had towards those associated with ‘immoral’ behaviour (e.g. sex workers). Eliminating HIV transmission misconceptions and addressing traditional gender attitudes are critical for reducing HIV stigma in Indian society.

From 1996 to 2006, Nepal experienced a substantial fertility decline, with the total fertility rate dropping from 4.6 to 3.1 births per woman. This study examines the associations between progress towards universal primary and secondary schooling and fertility decline in rural Nepal. Several hypotheses regarding mechanisms through which education affects current fertility behaviour are tested, including: the school environment during women's childhood; current availability of schools; knowledge of educational costs; and women's own educational attainment. Data for the analysis come from the 2003–04 Nepal Living Standards Survey, a nationally representative random sample of households, which includes detailed data on fertility, household expenditure, educational attainment, demographic characteristics and the use of social services. Census and administrative data are also used to construct district-level gross enrolment ratios for primary and secondary schools during the women's childhood. Discrete dependent variable modelling techniques are used to estimate the effects of the following variables on the probability of women giving birth in a given year: district-level gross enrolment ratios for primary and secondary schools during women's childhood; having had a child previously in school; women's own educational level; current school availability; and other covariates. Separate models are estimated for the overall sample of rural women of reproductive age, and for parity-specific sub-samples. The results suggest that district-level gross enrolment ratios for secondary schools and, in some instances, having had a previous child enrolled in school are significant determinants of fertility in rural areas. These results are highly independent of women's own educational levels. Overall, the results suggest that, in the rural Nepal context, mass schooling influences the fertility transition through both community- and household-level pathways.

This study considers the relationship between a cumulative index of biological dysregulation (allostatic load) and several dimensions of socioeconomic status (SES) and lifestyle in adult Polish males. The extent to which lifestyle variables can explain SES variation in allostatic load was also evaluated. Participants were 3887 occupationally active men aged 25–60 years living in cities and villages in the Silesia region of Poland. The allostatic load indicator included eleven markers: % fat (adverse nutritional intake), systolic and diastolic blood pressures (cardiovascular activity), FEV1 (lung function), erythrocyte sedimentation rate (inflammatory processes), glucose and total cholesterol (cardiovascular disease risk), total plasma protein (stress-haemoconcentration), bilirubin, creatinine clearance and alkaline phosphatase activity (hepatic and renal functions). A higher level of completed education, being married and residing in an urban area were associated with lower physiological dysregulation. The association between indicators of SES and allostatic load was not eliminated or attenuated when unhealthy lifestyle variables were included in the model. Smoking status and alcohol consumption played minimal roles in explaining the association between SES and allostatic load; physical activity, however, had a generally protective effect on allostatic load.

One of the most consistent findings in social epidemiology is an inverse relationship between indicators of SES and most types of illness. However, a growing body of research on HIV in sub-Saharan Africa suggests an intriguing reversal of this pattern, particularly with respect to HIV among women. In Cameroon, specifically, high-SES women have higher rates of HIV infection compared with low-SES women. Using data from the 2004 Cameroon DHS, this study explored the relationships between SES and HIV and tested a multivariate model designed to highlight the distinctive factors associated with increased risk of HIV among women in different SES classes. The results revealed that high-SES women who reported engaging in riskier sexual behaviour had the highest levels of HIV infection. Surprisingly, among this group increased knowledge of HIV, more domestic decision-making authority and access to health care did not reduce vulnerability. Meanwhile, among low-SES women relative gender inequality was significantly related to HIV risk. Specifically, among this group of women, having a partner with higher education was strongly associated with greater HIV risk. The results suggest that different approaches targeting each sub-group are needed to effectively combat the disease.

The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009–2010 community-based surveys in Nigeria and Zambia, this study explores whether women's knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women's HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.

Among women in mainland Tanzania, Iringa region in the southern highlands has the highest HIV/AIDS prevalence rate while Arusha region in the north-east has the lowest prevalence rate. In a 2007/8 survey, Iringa's HIV rate for women was 18.6% versus 0.8% in Arusha. Using data from a survey of women aged 15–49 years conducted in 2009 by the Champion project of EngenderHealth, a comparison was made of HIV/AIDS knowledge, attitude and practice between women in Iringa and Arusha regions. It was found that women in Arusha region had more knowledge of HIV/AIDS than women in Iringa region, and that more than three-quarters of the women in each region were married and 12% of the women in Arusha region had never been married compared with 8% of the women in Iringa region. The majority of women in each region had at least primary school education and there was no significant difference between their educational levels. Women in Arusha region were economically less active than women in Iringa region, a statistically significant association. More women in Arusha region than in Iringa region had never had children (24% versus 12%). Similarly, women in Arusha region had significantly fewer children compared with women in Iringa.

It is well known that height and weight are interrelated, and that both are related to socioeconomic variables. The objective of this study was to assess the effect of socioeconomic variables on the heights and weights of different groups of people, formed according to different levels of heights and weights, and to see whether there are sex differences in the variations in heights and weights. Data for adults aged 15–49 years were taken from the India National Family Health Survey-3 and descriptive studies and multiple linear regression analyses carried out. A clear positive association was found for height and BMI with economic level (except for overweight females in the case of BMI). In the case of BMI, it is age that seems to be the most influential factor. Surprisingly, the observed changes in height and BMI are not as expected for short and tall or underweight and overweight people; these sometimes behave in the opposite directions to that of normal height and weight people. The basic assumption of multivariate normality is not valid due to changing relations at different height and BMI levels.

Identification of modifiable factors and mediators linked to low and heavy birth weight is crucial in reducing infant mortality and health care expenditure. The present paper explores the associations of socio-demographic factors and immigrant status of parents with adverse pregnancy outcomes in Hong Kong. The analysis compares very low birth weight (VLBW: <1500 g), low birth weight (LBW: ≥1500 g and <2500 g) and heavy birth weight births (HBW: ≥4500 g) with births of normal weight (≥2500 g and <4500 g) using multinomial regression modelling of a large dataset of 828,975 births of singletons occurring between 1995 and 2009. The findings indicate the expected significant adverse associations between teenage and advanced age of the mother with compromised birth outcomes; teenage motherhood, however, has a protective effect against HBW births. A strong socioeconomic gradient is apparent, more marked among LBW births; low educational attainment of the father, low occupational class, public housing and single motherhood are strongly related to adverse pregnancy outcomes. Regarding immigrant status, women born in South and South-East Asia exhibit consistently higher odds of a compromised outcome. Women born in Hong Kong have significantly higher chances of LBW births while Mainland Chinese and parents from developed countries face higher odds of HBW births. The study identifies high-risk groups such as teenage, older and single mothers, South-East Asians and couples of low socioeconomic profile. Implementation of policies supporting these groups would be beneficial.

This paper investigates changes in BMI in the second half of the twentieth century, focusing on two cohorts of Italian conscripts born in 1951 and 1980, and examines how the correlates of high and low BMI have changed over time. Data from conscript cohorts taken from the archives of Italian military districts show that younger conscripts exposed to the rising prevalence of immune-allergological and psychological diseases and metabolic dysfunctions underwent substantial increases in weight. These results are evidenced by quantile regression models, the largest BMI gains being found in diabetic conscripts at the 75th and 90th percentiles.

This study investigated the trends in tuberculosis mortality through time in Switzerland. Information on the decline in mortality before chemotherapies were introduced may be useful in developing countries where drug-resistant tuberculosis is now becoming a major problem. Swiss data were collected from historical records and comparative data were obtained from the literature for England and Wales, New York, Japan, Brazil and Sierra Leone. Logistic curves were fitted to examine the rate of decline before introduction of pharmacotherapies and these show that the decline would have continued without the introduction of chemical therapies, including antibiotics. In Switzerland, England and Wales and New York, the decline had occurred long before the introduction of specific anti-tuberculosis agents. In Brazil and Japan, chemical therapy was co-incident with the decline in tuberculosis mortality rates. Overall, it is suggested that the effective control of tuberculosis can be achieved through a combination of chemical interventions, conservative therapy (rest, good nutrition, ventilation, etc.) as well as public health interventions addressing hygiene, nutrition, reducing exposure to infections and educating the population about tuberculosis.

The aim of this paper was to establish whether the influence of socioeconomic factors on BMI and the prevalence of underweight and overweight changes with age. The data were obtained from 1008 schoolgirls aged 16–18 years for whom earlier data on weight and height were available. Their height and body mass were measured and their BMIs calculated. Height and weight in early life were assessed by medical records review. The girls were measured by trained school nurses at 7, 9, 14 years of age. Socioeconomic differences in BMI were found to increase with age. Parents' higher education and urban environment were associated with smaller BMI gain between the ages of 7 and 18 years. Among subjects whose mother and/or father had higher education the prevalence of underweight increased with age, and in other groups it remained at a similar level. In the younger age categories (7- and 9-year-olds) underweight was less frequent in subjects from towns than those from rural areas, while in the older categories (14, 16–18 years of age) the opposite tendency was found. As subjects grew up, there was a decline in the prevalence of overweight and obesity in all groups. Parental education and place of residence seem to influence weight status in a different way in childhood than during adolescence.

Demographic research in India over the last two decades has focused extensively on fertility change and gender bias at the micro-level, and less has been done at the district level. Using data from the Census of India 1991–2011 and other sources, this paper shows the broad pattern of fertility transition and trends in the child sex ratio in India, and examines the determinants of the child sex ratio at the district level. During 1991–2011, while the Total Fertility Rate (TFR) declined by 1.2 children per woman, the child sex ratio fell by 30 points in the districts of India. However, the reduction in fertility was slower in the high-fertility compared with the low-fertility districts. The gender differential in under-five mortality increased in many districts of India over the study period. The decline in the child sex ratio was higher in the transitional compared with the low-fertility districts. The transitional districts are at higher risk of a low child sex ratio due to an increased gender differential in mortality and increase in the practice of sex-selective abortions. The sex ratio at birth and gender differential in mortality explains one-third of the variation, while region alone explains a quarter of the variation in the child sex ratio in the districts of India.

The combined effects of decreased fertility and mortality coupled with increasing survivorship across most ages have been upsetting the levels and age patterns of morbidity and mortality in India. This study examined data from the National Sample Survey (NSS) and Sample Registration System (SRS) of India. The results reveal marked structural changes in the age patterns of morbidity and mortality. The analysis also tested whether morbidity contours are being compressed or expanded, connecting it with the ongoing processes of demographic and epidemiological transition. The Sullivan (1971) method was used to estimate the health ratio over three time periods to ascertain the expansion of morbidity. The results reveal an exceptional rise in the prevalence rate of chronic non-communicable diseases in ages 60 and above. The proportion of unhealthy years of the total life expectancy has increased more than before for all older age groups. Overall, the results confirm that an expansion of morbidity is in progress, with a heavier and cumulated concentration of morbidity in older ages. The expansion of morbidity hypothesis is validated for major categories of population: rural, urban, male and female. Older females bear a much heavier burden of chronic non-communicable diseases and are vulnerable to a higher proportion of unhealthy years. The age-structural shifts in morbidity and mortality signal the steady progress of epidemiological transition in India.