Although the general objective of this study is to examine the extent to which spouses’ socioeconomic characteristics determine whether modern contraception is used and whether family limitation (the demand for no more children) is desired, its central goal is to evaluate the degree to which the net effect of a woman’s education on those fertility decisions is altered once a control is made for the level of schooling of the husband. Individual characteristics of spouses included as controls in this analysis are on the one hand women’s attributes relating to employment, age, parity, ethnic identity, and urban residence and, on the other hand, the occupation of the husband. Data used in this research are provided by DHS surveys conducted in fourteen sub-Saharan countries: Mali, Burkina Faso, Niger, Nigeria, Cameroon, Benin, Senegal, Ghana, Central African Republic, Kenya, Zambia, Zimbabwe, Namibia and Rwanda. With two dichotomous outcome variables, logistic regression was used to estimate two nested models for each dependent variable and for each country covered by the study. DHS respondents used as units of analysis in this study are women who were married (any kind of union) and non-pregnant at the time when each national survey was conducted. The findings suggest that, while an educated wife needs the support of an educated husband to state a preference for family limitation in contemporary sub-Saharan Africa, controlling for husband’s education and other relevant covariates does little to undermine the evidence that woman’s advanced education and the adoption of modern family planning are positively related in the developing world.

Using data obtained in 1995 from 600 Atyap women in randomly selected dwellings in Kaduna State, Nigeria, multiple regression analysis shows that Catholics and Other Protestants (Anglicans and Baptists) have higher fertility than women affiliated to the Evangelical Churches of West Africa (ECWA), even net of compositional characteristics of the two groups. Above and beyond the denominational differences, the regression analysis also shows that the stronger the religious belief, the higher the fertility. Thus, the study underscores the need for researchers of the religion–fertility association in Nigeria to examine the influence of religious denomination and religiosity on fertility, within each of the main religions.

The primary objective of this report is to use data from a study of infant growth and weaning practices in Kathmandu, Nepal, to investigate universal recommendations about exclusive breast-feeding up to 6 months postpartum. A secondary objective is to demonstrate the complexity of the biocultural nature of infant feeding practices. A sample of 283 children under 5 years of age and their 228 mothers living in a peri-urban district of Kathmandu participated in this study. The children’s height/length and weight were measured three times over 9 months. At each session, a demographic, child health and infant feeding survey was administered; between sessions, in-depth interviews were conducted with mothers regarding infant feeding practices. While a few of the infants under 2 months were receiving non-breast milk foods, at 3 months of age half of the sample had been introduced to non-breast milk foods and by 7 months all infants were eating non-breast milk foods. A comparison of growth indices and velocities between exclusively and partially breast-fed infants from birth to 7 months of age shows no evidence for a difference in nutritional status between the two groups. Although there are cultural rules about breast-feeding that vary by ethnic group, all mothers followed a feeding method that depended on their assessment of whether the child was getting enough breast milk. The conclusion is that exclusive breast-feeding up to 6 months may not be appropriate for all infants. In this sample, breast-feeding duration is not shortened by the early introduction of non-breast milk foods, as the median age of breast-feeding cessation is 36 months. One of the main reasons for severance was the onset of another pregnancy. Investigation of infant feeding practices must be contextualized in the local ecology of the population. While cultural beliefs about breast-feeding are relevant, mothers’ individual assessments of their children’s nutritional needs and demographic events in parents’ lives must also be considered.

Indicators of family planning service access and quality were generated using the Egypt DHS-I (1988) and the Egypt Service Availability Survey (1989), and linked to episodes of contraceptive pill use. Multilevel analysis was used to ascertain whether or not these access and quality indicators influence the continuation of pill use, net of women’s socioeconomic, demographic and motivational characteristics. A model with random components at the cluster and women levels was fitted for all reasons of discontinuation, except desire for pregnancy, at 24 months of use. Net of women’s background characteristics, the results show that facilities with smaller numbers of health personnel trained in family planning, a lack of access to facilities with female doctors and a lack of range of available methods are associated with a high risk of discontinuation of pill use for all reasons except desire for pregnancy.

There is increasing interest in the nature and biological significance of romantic love but few quantitative data are available for testing specific hypotheses. This paper describes the use of a survey instrument to assess incidence and duration of romantic attractions over a 2-year period amongst students (121 male; 162 female) progressing from school to university education. The results for males and females were similar and schooling – single-sex or co-educational – had little effect. Students averaged 1·45 romantic episodes per year and 93% of students reported at least one episode over the survey period. Duration of attraction was around 9 weeks if never reciprocated and around 12 weeks if reciprocated. There was seasonal variation of onset of episodes with peak incidence over the summer or early autumn seasons. Collectively the results accord with the view that frequent, short-duration romantic episodes could have a role in selection of appropriate long-term reproductive partnerships.

The 1998 El Niño significantly reduced garden productivity in the Upper Orinoco region in Venezuela. Consequently, parents were forced to allocate food carefully to their children. Nutrition data collected from village children combined with genealogical data allowed the determination of which children suffered most, and whether the patterns of food distribution accorded with predictions from parental investment theory. For boys, three social variables accounted for over 70% of the variance in subcutaneous fat after controlling for age: number of siblings, age of the mother’s youngest child, and whether the mother was the senior or junior co-wife, or was married monogamously. These results accord well with parental investment theory. Parents experiencing food stress faced a trade-off between quantity and quality, and between investing in younger versus older offspring. In addition, boys with access to more paternal investment (i.e. no stepmother) were better nourished. These variables did not account for any of the variance in female nutrition. Girls’ nutrition was associated with the size of their patrilineage and the number of non-relatives in the village, suggesting that lineage politics may have played a role. An apparent lack of relationship between orphan status and nutrition is also interesting, given that orphans suffered high rates of skin flea infections. The large number of orphans being cared for by only two grandparents suggests that grooming time may have been the resource in short supply.

Although Kenya’s fertility rate has declined from 6·7 births per woman in the mid-1980s to 5·4 births per woman in 1993 (NCPD, 1994), population growth is still high, yielding a doubling time of 35 years. This study uses the 1993 Kenya Demographic Health Survey data collected from 1257 couples to examine the socioeconomic and sociodemographic characteristics of married men and women and their communication with their spouses over fertility and family planning decision-making practices. The logistic regression analysis shows that education for both men and women, discussion of fertility and family planning between spouses, male approval of use of contraception and male family size desires are important factors that influence ever-use of family planning.

This paper uses data collected using in-depth, semi-structured interviews to examine utilization of maternal health care services among two rural and urban populations of Pune and Mumbai in Maharashtra, India. The study aims to identify key social, economic and cultural factors influencing women’s decisions to use maternal health care and the places used for child delivery, whilst considering the accessibility of facilities available in the local area. Socioeconomic status was not found to be a barrier to service use when women perceived the benefits of the service to outweigh the cost, and when the service was within reasonable distance of the respondent’s place of residence. A large number of women perceived private services to be superior to those provided by the government, although cost often meant they were unable to use them. The provision of services did not ensure that women used them; they had to first perceive them to be beneficial to their health and that of their unborn child. Respondents identified the poor quality of services offered at government institutions to be a motivating factor for delivering at home. Thus further investigation is needed into the quality of services provided by government facilities in the area. A number of respondents who had received antenatal care went on to deliver in the home environment without a trained birth attendant. Further research is needed to establish the types of care provided during an antenatal consultation to establish the feasibility of using these visits to encourage women, particularly those with high-risk pregnancies, to be linked to a trained attendant for delivery.

This study uses data from the 1992–93 National Family Health Survey to assess trends in consanguinity in the South Indian states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. In Kerala, the frequency of consanguineous marriages is very low and one type of preferred marriage of the Dravidian marriage system – uncle–niece marriage – is conspicuously absent. In the other states of South India, consanguinity and the coefficient of inbreeding are high. While no change in consanguinity is observed during the past three to four decades in Karnataka, a definite decline is observed in Andhra Pradesh and Tamil Nadu. Due to recent changes in the demographic and social situation in these states, this decline in consanguinity is likely to continue.

A large multicentre epidemiological study was carried out by WHO between 1991 and 1995 to analyse the duration of lactational amenorrhoea in relation to breast-feeding. The main results of this analysis, which used classical statistical modelling, have been already published. However, some specific aspects of the postpartum fertility amenorrhoea and breast-feeding covariates, and more specifically the observed progressive exhaustion of the breast-feeding inhibitory effect on the reproductive axis, may justify a closer look at the validity of the statistical tools. Indeed, as has already been emphasized, analysis of large longitudinal data sets in reproduction often faces three difficulties: (i) the precise determination of the event of interest, (ii) the way to handle the time evolution of both the studied variables and their effect on the event of interest and (iii) the often discrete nature of the data and the associated problem of tied events. The first objective of the present work was to give additional insights into the estimation and quantification of the dynamics of the effect of breast-feeding over time, considering this covariate either as fixed or time-dependent. The second objective was to show how to perform the analyses using corresponding adapted procedures in widely available statistical packages, without the need for acquiring particular programming skills.

Machado-Joseph Disease (MJD) is an autosomal dominant neurodegenerative disorder of adult onset, associated with the expansion of a (CAG)n tract in the coding region of the causative gene, localized on 14q32.1. Machado-Joseph Disease shows non-Mendelian features typical of other triplet repeat disorders, including clinical heterogeneity, variable age at onset and anticipation. Three phenotypes have been proposed (clinical types 1, 2 and 3). Type 1 is associated with early age at onset and a high repeat number of the CAG sequence, and Types 2 and 3 have later onset and lower numbers of CAG repeats. This paper investigates whether there is selection against the MJD gene, acting through differential survival, nuptiality and fertility associated with clinical type and age at onset. The study sample comprised 40 MJD patients from the Azores (Portugal) having fully documented reproductive histories and known dates of death. The proportion of married patients of each clinical type increased from 0·22 among Type 1 patients, to 0·40 in Type 2 and 0·95 in Type 3. Age at onset and length of survival were also associated with marital status, with the married cases having later mean age at onset and longer mean survival time. In the whole sample, clinical type was associated with fertility, with significantly fewer children born to Type 1 patients. Among married patients clinical type was not associated with age at marriage, reproductive span or number of children. No reduction of fertility was detected among married patients in whom the onset of MJD was below the age of 50. The authors’ interpretation of these results is that the high-repeat CAG haplotypes associated with early age at onset and clinical Type 1 are selected against through reduced survival and fertility. The fertility component of selection is mediated by nuptiality rather than marital fertility.

Surnames of grandparents were collected from children in the primary schools of the Albanian–Italian, Croat–Italian and Greek–Italian villages of southern Italy and Sicily. The coefficients of relationships by isonymy show almost no relationship with ethnicity. Ethnolinguistic minorities of southern Italy and Sicily are geographically subdivided into two main clusters: the first cluster comprises the Albanian, Croat and Greek communities of the Adriatic area; and the second cluster comprises the Albanian and Greek communities of the Ionian, Thirrenian and Sicilian areas.

This paper examines the association of the sociodemographic characteristics of women and the unobserved hospital factors with maternal mortality in Kenya using multilevel logistic regression. The data analysed comprise hospital records for 58,151 obstetric admissions in sixteen public hospitals, consisting of 182 maternal deaths. The results show that the probability of maternal mortality depends on both observed factors that are associated with a particular woman and unobserved factors peculiar to the admitting hospital. The individual characteristics observed to have a significant association with maternal mortality include maternal age, antenatal clinic attendance and educational attainment. The hospital variation is observed to be stronger for women with least favourable sociodemographic characteristics. For example, the risk of maternal death at high-risk hospitals for women aged 35 years and above, who had low levels of education, and did not attend antenatal care is about 280 deaths per 1000 admissions. The risk for similar women at low-risk hospitals is about 4 deaths per 1000. To complement results from the analysis of individual patient records, the paper includes findings from hospital staff reports regarding the maternal mortality situation at the hospitals.

This paper describes the efforts of Family Health International to develop a simple, standard and replicable methodology to estimate expenditures on family planning in developing countries. The study found that it is not possible, at least at this time, to develop such a methodology. Numerous problems were encountered in making expenditure estimates. First and most important, expenditure accounts are not always readily available. Even when these accounts are available, they may require some adjustments. In some instances, for example, the salaries of health workers who also provide family planning are in the health accounts, whereas in other cases the workers covered in the family planning accounts spend some of their time providing health services. Allocation variables then must be developed to separate spending on family planning from that on health. In some instances allocation variables were developed and used to separate family planning from health expenditures, but in this case allocation variables were not available and a cost analysis was performed. It is concluded that it takes considerable time and effort to estimate expenditures, and that the approach that was followed varied by country, reflecting the data available to make estimates.

This paper uses data from the 1995/96 Mali DHS survey to examine the importance of a wide range of socioeconomic, behavioural and biodemographic factors in the determination of child mortality in Mali, with a special focus on maternal education and behaviour. The central hypothesis of the study is that advances in maternal education would contribute little to child survival in settings such as Mali’s urban and rural communities where progress in educational attainment is not matched with improvements in other aspects of socioeconomic development such as economic growth, job creation, financial security and public health and medical resources. Units of analysis are children born in the past 5 years to DHS respondents (women aged 15–45) who were married at the time of the survey. The Cox proportional hazards regression technique has been used to estimate the net effects of variables included as covariates. The findings indicate that the health-seeking behaviour of the mother matters more than maternal education in explaining the observed differences in infant and child mortality in Mali’s urban and rural areas.

Studies addressing factors associated with adverse birth outcomes have almost exclusively been based on hospital statistics. This is a serious limitation in developing countries where the majority of births do not occur within health facilities. This paper examines factors associated with premature deliveries, small baby’s size at birth and Caesarean section deliveries in Kenya based on the 1993 Kenya Demographic and Health Survey data. Due to the hierarchical nature of the data, the analysis uses multilevel logistic regression models to take into account the family and community effects. The results show that the odds of unfavourable birth outcomes are significantly higher for first births than for higher order births. Furthermore, antenatal care (measured by frequency of antenatal care visits and tetanus toxoid injection) is observed to have a negative association with the incidence of premature births. For the baby’s size at birth, maternal nutritional status is observed to be a predominant factor. Short maternal stature is confirmed as a significant risk factor for Caesarean section deliveries. The observed higher odds of Caesarean section deliveries among women from households of high socioeconomic status are attributed to the expected association between socioeconomic status and the use of appropriate maternal health care services. The odds of unfavourable birth outcomes vary significantly between women. In addition, the odds of Caesarean section deliveries vary between districts, after taking into account the individual-level characteristics of the woman.

This ecological study examines the variations in diarrhoea-specific infant mortality rates among municipalities in the State of Ceará, north-east Brazil, using data from a community health workers’ programme. Diarrhoea is the main cause of postneonatal deaths in Ceará, and diarrhoea mortality rates vary substantially among municipalities, from 7 to 50 per thousand live births. To determine the inter-relationships between potential predictors of diarrhoea-specific infant mortality, eleven variables were classified into proximate determinants (i.e. adequate weight gain and exclusive breast-feeding in first 4 months) and underlying determinants (i.e. health services and socioeconomic variables). The health services variables included percentage with prenatal care up-to-date, participation in growth monitoring and immunization up-to-date, while the socioeconomic factors included female illiteracy rate, per capita gross municipality product and percentage of households with low income, percentage of households with inadequate water supply and inadequate sanitation, and urbanization. Using linear regression analysis variables were included from each group to build regression models. The significant determinants of variability in diarrhoea-specific infant mortality between municipalities were prevalence of infants exclusively breast-feeding, percentage of infants with adequate weight gain, percentage of pregnant women with prenatal care up-to-date, female illiteracy rate and inadequate water supply. These findings suggest that community-based promotion of exclusive breast-feeding in the first 4 months and care-giving behaviours that prevent weight faltering, including weaning practices and feeding during and following diarrhoea episodes, may further reduce municipality-level diarrhoea-specific mortality. Primary heath care strategies addressing these two proximate determinants provide only a partial solution to reducing diarrhoeal disease mortality. Improvements in municipal health services (prenatal care) and socioeconomic status variables, including water supply and maternal education, can also contribute to reduction of infant mortality due to diarrhoea. These results may be used by government health officials to set priorities by considering not only the strength of the association between selected risk factors and diarrhoea mortality rates, but also the prevalence of the risk factors being considered at the municipality level. Finally, the methods used are applicable to other settings with community-based primary health care decentralized to the state or municipal level.

This study, conducted in Kisumu District, Kenya, identified important risk factors for infection with intestinal helminths using traditional epidemiological methods. This was combined with a rapid assessment study using qualitative methods, which focused on sanitation practices and local illness perceptions. The multiple logistic regression analysis revealed that the absence of latrines was a significant predictor for hookworm infection with an odds ratio (OR) of 1·9. The analysis also revealed that households without soap had a 2·6 times higher risk of being infected with Ascaris lumbricoides compared with households where soap was available, and that the number of inhabitants living in a household was a significant predictor for infections with hookworms (OR=3.2). Furthermore, the presence of children of 5 years and under in the household was a predictor for infection with A. lumbricoides (OR=2.7), while the absence of this age group was a predictor for hookworm infection (OR=3.8). The qualitative part of the study revealed that people did not consider worms as a serious health threat, but as a nuisance. Among the population, latrines were seen as beneficial because they were believed to prevent disease, to provide privacy and to keep the environment free of faeces. Handwashing was done many times a day but usually not with soap, which was mainly used when bathing or washing the whole body. Many inhabitants in a household or the presence of children of 5 years and under were never mentioned as being a disadvantage, and these elements would therefore be difficult to include in a control strategy. Since the lack of latrines and of soap were identified as risk factors for infection, while latrines, soap and medicine were seen as assets by the population, it is suggested that helminth control interventions should be concentrated within these areas in this particular society.

The purpose of this study was to investigate the socioeconomic, biological and behavioural factors influencing low birth weight and prematurity in Botswana. Data were from the Botswana Obstetric Record covering the years 1990 to 1995, and were analysed with both descriptive statistics and multivariate analysis. The study found that the major positive risk factors for low birth weight were: late and less frequent attendance of antenatal care services, having experienced pregnancy termination before, low or no education, unmarried motherhood and place of birth. With regard to prematurity, age, late and less frequent attendance of antenatal care services, unmarried motherhood and place of birth were found to be the major positive risk factors. The importance of early and regular antenatal care attendance, marriage and place of birth cut across both low birth weight and prematurity.

From 626 ascendant genealogies, known as ‘birth briefs’, deposited by members of the Society of Genealogists in their London library, rates of consanguineous marriage and coefficients of mean inbreeding (α) of offspring were estimated for cohorts of marriages contracted in the late nineteenth and early twentieth centuries. The rate of first cousin marriage in the generation estimated to have married during the 1920s was 0·32%, with no marriages between second cousins. The mean inbreeding coefficient for the offspring of these marriages was estimated as 0·0002. In the previous generation 1·12% of the marriages were between first cousins, and the estimate of mean inbreeding was 0·0007. Comparison with data taken from the published literature suggests that the levels of cousin marriage observed are consistent with a secular decline during the late nineteenth and twentieth centuries.