This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2000 g) contributed 75·6% of the population-attributable risks to stillbirths and 59·4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77·7% of stillbirths and 87·9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study.

In South Africa, disability grant allocation has been under review and tensions are evident in government rhetoric stressing welfare provision on the one hand, and encouraging ‘rationalization’ on the other. This ambiguity is traced down to the level of grant negotiations between doctors and ‘clients’ in a psychiatry clinic in Khayelitsha. Here ‘having nerves’ embodies the distress associated with harsh circumstances and is deemed by supplicants as sufficient to secure a grant. The paper illustrates how national discourses influence the presentation and experience of suffering and the way in which doctors mediate diagnoses. The implications of local understandings of ‘health citizenship’ for expectations of the post-apartheid state are explored.

In its recently adopted Global Strategy on Infant and Young Child Feeding, the World Health Assembly called for urgent action in addressing the barriers to optimal feeding practices. This paper examines mothers’ concerns about milk insufficiency as a major contributor to suboptimal infant feeding decisions, using survey data from periurban areas of two Bolivian cities. Mothers in the lowland modernizing city of Santa Cruz were more likely than mothers in the highland traditional city of Cochabamba to express concern about insufficient milk, and also less likely to feed their infants according to international recommendations. Furthermore, perceived milk insufficiency was particularly common among mothers of infants younger than 6 months of age – an age at which infants are particularly vulnerable to the adverse effects of breast-feeding cessation and complementary feeding initiation. The paper concludes with policy, programme and research recommendations to address the critical problem of perceived insufficient breast milk.

Malaria remains one of the main causes of mortality among young children in sub-Saharan Africa. In Nigeria traditional healers play an important role in health care delivery and the majority of the population depend on them for most of their ailments. The aim of this study was to investigate the perceptions of traditional healers regarding causes, symptoms, treatment of uncomplicated malaria and referral practices for severe malaria with a view to developing appropriate intervention strategies aimed at improving referral practices for severe malaria. A qualitative study was carried out in Ugwogo-Nike, a rural community in south-east Nigeria, which included in-depth interviews with 23 traditional healers. The traditional healers believed that the treatment of severe malaria, especially convulsions, with herbal remedies was very effective. Some traditional healers were familiar with the signs and symptoms of malaria, but malaria was perceived as an environmentally related disease caused by heat from the scorching sun. The majority of traditional healers believed that convulsions are inherited from parents, while a minority attributed them to evil spirits. Most (16/23) will not refer cases to a health facility because they believe in the efficacy of their herbal remedies. The few that did refer did so after several stages of traditional treatment, which resulted in long delays of about two weeks before appropriate treatment was received. The fact that traditional healers are important providers of treatment for severe malaria, especially convulsions, underlines the need to enlist their support in efforts to improve referral practices for severe malaria.

This paper argues for the inclusion of ethnography as a research methodology for understanding the effects of public health policy. To do this, the implementation of DOTS (Directly Observed Therapy, Short-course) – the World Health Organization (WHO) prescribed policy for the control of the infectious disease tuberculosis – is explored in the context of Nepal. A brief history of DOTS and its implementation in Nepal is outlined, and the way it has been represented by those within the Nepal Tuberculosis Programme (NTP) is described. This is followed by an outline of the research done in relation to this, and the ethnographic methods used. These ethnographic data are then interpreted and analysed in relation to two specific areas of concern. Firstly, the effects around the epidemiological uses of ‘cases’ is explored; it is argued that a tightening of the definitional categories so necessary for the programme to be stabilized for comparative purposes has profound material effects in marginalizing some from treatment. Secondly, the paper examines some of the implications and effects relating to the way that the ‘directly observed’ component was implemented. The discussion explores how current debate on DOTS has been played out in some medical journals. It argues for the importance of ethnography as a method for understanding certain questions that cannot be answered by particular, and increasingly dominant, research ideologies informed by randomized controlled trials. This raises important issues about the nature of ‘evidence’ in debates on the relationship of research to policy.

Contraceptive prevalence has been central to family planning research over the past few decades, but researchers have given surprisingly little consideration to method mix, a proxy for method availability or choice. There is no ‘ideal’ method mix recognized by the international community; however, there may be reason for concern when one or two methods predominate in a given country. In this article method skew is operationally defined as a single method constituting 50% or more of contraceptive use in a given country. Of 96 countries examined in this analysis, 34 have this type of skewed method mix. These 34 countries cluster in three groups: (1) sixteen countries in which traditional methods dominate, most of which are in sub-Saharan Africa; (2) four countries in which female sterilization predominates (India, Brazil, Dominican Republic and Panama); and (3) fourteen countries that rely on a single reversible method (the pill in Algeria, Kuwait, Liberia, Morocco, Sudan and Zimbabwe; the IUD in Cuba, Egypt, Kazakhstan, Kyrgyz Republic, Moldova, Turkmenistan and Uzbekistan; and the injectable in Malawi). A review of available literature on method choice in these countries provides substantial insight into the different patterns of method skew. Method skew in some countries reflects cultural preferences or social norms. Yet it becomes problematic if it stems from restrictive population policies, lack of access to a broad range of methods, or provider bias.

The objective of this study was to identify the key determinants of condom use with regular and casual partners among youth in Madagascar. Data stem from a reproductive health survey conducted in October–December 2000 among a representative sample of 2440 youth aged 15–24 living in Toamasina province. Following theoretical models of behaviour change, logistic regression was used to assess the effect of AIDS awareness, personal risk perception, condom access, perceived condom effectiveness, self-efficacy and social support on condom use. Among sexually experienced youth, only about four in ten males and two in ten females have ever used condoms. Fewer than 15% of youth used a condom in last intercourse with their regular partner. Whether youth will try condoms appears to depend largely on the perceived effectiveness of condoms for family planning, access to a nearby condom source, parental support for condom use, and patterns of risky sexual behaviour. Young males’ likelihood of using a condom with a regular partner increases significantly if they perceive condoms to be effective for family planning (OR=11·4; p=0·019). For females, it increases with level of self-efficacy (OR=2·1; p=0·042) and having discussed HIV prevention with someone in the last year (OR=2·8; p=0·022). Among males, condom use with casual partners is significantly higher among those who perceive themselves to be at high risk of sexually transmitted infections (OR=2·3; p=0·014), who believe condoms are effective for family planning (OR=2·8; p=0·048), who have good access to condoms (OR=2·9; p=0·002) and who perceive their parents support condom use (OR=1·7; p=0·048). In conclusion, very few youth in Toamasina are using condoms, highlighting the need to continue and expand adolescent reproductive health interventions. In this low HIV prevalence setting, it is important for these programmes to emphasize that condoms are effective for both pregnancy prevention and STI/HIV prevention.

Understanding treatment-seeking practices for malaria in pregnancy is necessary in designing effective programmes to address the high malaria morbidity in pregnancy. This study assessed women’s perceptions on malaria in pregnancy, recognition of early signs of pregnancy and of malaria, and the cultural context in which treatment seeking takes place in Mukono District. Focus group discussions (FGD) and key informant interviews were conducted among pregnant women, non-pregnant women, adolescents and men. The results showed that malaria, locally known as omusujja, was perceived as the most common cause of ill health among pregnant women. Although malaria commonly presents with fever, some pregnant women feel hot in the womb with or without signs of fever and this illness, locally known as nabuguma, may lead to progressive weakness and occasionally to miscarriage and few respondents associated it with malaria. Primigravidae, adolescents and men were not considered at risk of omusujja or nabuguma. Similarly anaemia and low birth weight were not associated with malaria; in fact paleness was described as a normal sign of pregnancy. There are cultural and social pressures on married women to get pregnant and this forces them to conceal symptoms like feeling feverishness, backache, nausea, general weakness, loss of appetite and vomiting until they are sure these are due to pregnancy. Most women, however, could not differentiate symptoms of malaria from those of early pregnancy. There is a belief that omusujja is a normal sign of pregnancy and this is coupled with a strong cultural practice of using herbs and clays as a first resort to treat pregnancy ailments including malaria. The cultural beliefs and practices regarding delivery of twin and first births, coupled with the high cost of care, prevent women from delivering and using other services at health units.

Contraceptive prevalence is a key variable estimated from Demographic and Health Surveys. But the prevalence estimated from reports of husbands differs widely from that estimated for wives. In this research, using data from six Demographic and Health Surveys of sub-Saharan Africa, reports from spouses in monogamous couples with no other reported sex partners in the recent period are examined. Agreement ranged from 47% to 82%, but among couples in which one or both reported use, the ‘both’ category represented less than half in all nations except Zimbabwe. Husbands generally had higher reports of condoms, periodic abstinence and pills but fewer reports of the IUD, injections and female sterilization. Either discussion of family planning with the spouse and/or higher socioeconomic status was associated with agreement in most of the surveys. Ambiguities in the survey question regarding current use need to be reduced, perhaps with an added probe question for non-permanent methods.

This paper elaborates the hypothesis that the unique demography and sociology of Ashkenazim in medieval Europe selected for intelligence. Ashkenazi literacy, economic specialization, and closure to inward gene flow led to a social environment in which there was high fitness payoff to intelligence, specifically verbal and mathematical intelligence but not spatial ability. As with any regime of strong directional selection on a quantitative trait, genetic variants that were otherwise fitness reducing rose in frequency. In particular we propose that the well-known clusters of Ashkenazi genetic diseases, the sphingolipid cluster and the DNA repair cluster in particular, increase intelligence in heterozygotes. Other Ashkenazi disorders are known to increase intelligence. Although these disorders have been attributed to a bottleneck in Ashkenazi history and consequent genetic drift, there is no evidence of any bottleneck. Gene frequencies at a large number of autosomal loci show that if there was a bottleneck then subsequent gene flow from Europeans must have been very large, obliterating the effects of any bottleneck. The clustering of the disorders in only a few pathways and the presence at elevated frequency of more than one deleterious allele at many of them could not have been produced by drift. Instead these are signatures of strong and recent natural selection.

Using the nationally representative sample of about 15,000 Add Health respondents in Wave III, the hypothesis is tested that masculinity–femininity in adolescence is correlated with sexual orientation 5 years later and 6 years later: that is, that for adolescent males in 1995 and again in 1996, more feminine males have a higher probability of self-identifying as homosexuals in 2001–02. It is predicted that for adolescent females in 1995 and 1996, more masculine females have a higher probability of self-identifying as homosexuals in 2001–02. Masculinity–femininity is measured by the classical method used by Terman & Miles. For both time periods, the hypothesis was strongly confirmed for males: the more feminine males had several times the probability of being attracted to same-sex partners, several times the probability of having same-sex partners, and several times the probability of self-identifying as homosexuals, compared with more masculine males. For females, no relationship was found at either time period between masculinity and sex of preference. The biological mechanism underlying homosexuality may be different for males and females.

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.

This study examines the frequency of consanguineous marriage and coefficient of inbreeding in the State of Qatar. The study was conducted in semi-urban areas of Doha between January and May 2004. A sample of 1515 married Qatari females aged 15 years and over participated. The degree of consanguinity between each female and her spouse, and degree of consanguinity between their parents were recorded. The rate of consanguinity in the present generation was high (54·0%) with a coefficient of inbreeding of 0·02706. The commonest type of consanguineous marriage was between first cousins (34·8%). Double first cousin marriages were common (3·1%) compared with other populations. The consanguinity rate in the State of Qatar has increased from 41·8% to 54·5% in one generation.

Surnames provide a useful method to study the structure of human populations for which biological data are not available. The isonymic method has had multiple applications, but difficulties emerge when dealing with groups where extramarital reproduction is common and the sample size is small, and even more so when only paternal surnames are taken into account. Therefore, it could be of interest to retain female surnames, including those of unmarried mothers. This study was carried out using all birth records from an Argentinian population in the colonial period, which was characterized by the presence of different ethno-social groups (Spanish, Indian and ‘Mestizo’ or mixed Spanish–Indian) and various reproductive patterns regarding legitimacy. Coefficient of relationship by isonymy (Ri) kinship matrices between geographical populations were obtained, and the results derived from sets of surnames (paternal, maternal of legitimate and illegitimate children, and all surnames in the registers) compared. The results show similar surname distribution regardless of the set of surnames and group considered. Kinship Ri matrices using paternal surnames, maternal surnames of legitimate children, maternal surnames of illegitimate children, and the set of whole surnames showed the same relationships among populations, indicating a similar pattern for Spanish, Indian and Mixed ethno-social groups. Mantel test correlation between all pairs of matrices was significant in all different ethno-social groups. The results suggest that in populations with high illegitimacy, such as that studied here, it is possible to include maternal surnames, even corresponding to single mothers, in order to consider total reproduction and therefore maximize sample size.

The aim of this study is to analyse the impact of maternal age at first birth on low birth weight, preterm birth and low Apgar scores at one minute and at five minutes among live births delivered to primiparous Brazilian women in the city of São Paulo. Analyses were based on 73,820 birth records from the 1998 birth cohort. Logistic regression was used to assess the association between maternal age and each outcome variable, controlling for the following risk factors: delivery mode, plurality, sex, maternal education, number of prior losses, prenatal care, race, parity and community development. Maternal ages below 20 and above 30 years were significantly associated with the risks of low birth weight and preterm birth, but no association was found between maternal ages and Apgar score, with the exception that ages 15–19 reduced the odds of a low one-minute score. Even though this result seems to be inconsistent, low birth weight, preterm birth and low Apgar scores measure different dimensions of newborn well-being, and the association of each measure with maternal age is expected to diverge.

This paper interrogates the routine and unproblematic use of terms such as ‘self-medication’ in biomedical and anthropological discourse. A typical depiction of the social factors that explain the practice of ‘self-medication’ in India is to put together the supply side factors (such as protection offered by the government for the production of generic drugs, especially in the small scale sector, and expansion of the number of drug store outlets), with the increasing demand for allopathic drugs. The paper provides an ethnographic account of the intricate connections between households and biomedical practitioners in urban neighbourhoods in Delhi. It breaks away from the conventional opposition drawn between the practices of physicians and the beliefs of their patients, and suggests that what constitutes the medical environments of these neighbourhoods is the product of medical practices, household economies and concepts of disease. Thus pharmaceutical use is determined as much by practices of dispensation and by how practitioners understand what constitutes therapy as by household understanding of the normal and the pathological. This paper uses both quantitative data and narrative interviews to provide an in-depth understanding of the circulation of pharmaceuticals within the life worlds of the urban poor.

Little is known about the biting nuisance of mosquitoes in the UK, despite the high numbers found in some locations. A telephone questionnaire survey was used to determine the perceived nuisance of biting insects on the Isle of Sheppey, Kent, a place notorious for mosquitoes. Two hundred randomly selected individuals were interviewed and asked if they suffered from mosquito bites. If they answered yes, they were asked to describe where and when they were bitten, and what measures they took against mosquitoes. Forty-six per cent of respondents completed the questionnaire. Of those, 50% reported being bitten by mosquitoes, mostly outside during the summer. Seventy per cent said that most biting occurred during the evening and night. Of those respondents who protected themselves against biting (27), most used repellents (70%), with the remainder changing their behaviour to avoid mosquitoes, including closing or screening windows (33%), wearing thicker clothes (7%) and spraying insecticide (4%). One person slept under a bednet in summer (4%). This study provides evidence that on the Isle of Sheppey mosquitoes are considered a major nuisance by a sizeable proportion of the population. Since there is growing interest in the threat posed by new and emerging diseases in the UK, health authorities will need to make substantial efforts to inform and reassure the public about the threats posed by mosquitoes in areas where they are common.

Birth order is correlated with male sexual orientation, but the reason(s) for this relationship is unclear. In the present study, data from a Canadian sample of homosexual and heterosexual men (N=604) were used to present evidence of two independent birth order interactions – one with height and the other with parental age – predicting sexual orientation in men. If these findings prove reliable, it raises the possibility that different aetiological factors underlie the birth order/sexual orientation relationship in men.

This article attempts to evaluate men’s approval of family planning in Bangladesh using the couple data set from the recent Bangladesh Demographic and Health Survey (BDHS), 1999–2000. Family planning approval is addressed both from individual and couple perspectives. Analysis of BDHS data shows that about 85% of the wives report that their husbands approve of family planning, which is lower than the wives’ own approval rate (95%). Using the couple data set, husbands’ characteristics were matched to the wives’ responses on family planning approval. Regression analyses show that age, education, access to TV, inter-spousal communication, current use of family planning and the number of living children significantly determine family planning approval among both men as well as couples. Family planning approval was found to be much lower in Sylhet than in the other administrative divisions. Multilevel modelling analysis suggests almost negligible variation at the community level. The findings indicate the need for careful evaluation of the DHS questions in order to measure appropriately men’s family planning attitudes.

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.