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Biomedical subjects

S S Bloom

Publications and source records attributed to S S Bloom.

8 recordsLinked to original sources
PubMed2002

Community effects on the risk of HIV infection in rural Tanzania.

OBJECTIVES: To investigate the effect of community characteristics on HIV prevalence and incidence. METHODS: Data from an open cohort study with demographic surveillance, epidemiological surveys, and qualitative research were used to examine the association between individual and community risk factors with HIV prevalence in 1994-5 and incidence between 1994-5 and 1996-7 among men (n=2271) and women (n=2752) living in a rural area in northwest Tanzania. Using subvillages as the unit of analysis, community factors investigated were level of social and economic activity, ratio of bar workers per male population aged 18-59, level of community mobility, and distance to the nearest town. Logistic and Cox regression models were estimated to assess community effects, controlling for multiple individual factors. RESULTS: All four community factors had strong effects on HIV transmission. Men who lived in subvillages with the highest level of social and economic activity had an odds of being HIV positive that was about five times higher (OR=4.71, 95% CI=2.89 to 6.71) than those in places with low levels of activity; women in these subvillages had an odds that was twice as high (OR=1.92, 95% CI=1.27 to 2.92). After controlling for community effects, the effects of some individual factors on the risk of HIV-education, male circumcision, type of work, and number of household assets-changed notably. The association between HIV incidence and community factors was in the expected direction, but did not reach statistical significance (RR=2.07, p=0.10). CONCLUSIONS: Results suggest that community characteristics play an important part in the spread of HIV in rural Tanzania. Community effects need both to be considered in individual risk factor analyses and be given more attention in intervention programmes.

Adult↗
PubMed2001

Dimensions of women's autonomy and the influence on maternal health care utilization in a north Indian city.

The dimensions of women's autonomy and their relationship to maternal health care utilization were investigated in a probability sample of 300 women in Varanasi, India. We examined the determinants of women's autonomy in three areas: control over finances, decision-making power, and freedom of movement. After we control for age, education, household structure, and other factors, women with closer ties to natal kin were more likely to have greater autonomy in each of these three areas. Further analyses demonstrated that women with greater freedom of movement obtained higher levels of antenatal care and were more likely to use safe delivery care. The influence of women's autonomy on the use of health care appears to be as important as other known determinants such as education.

Cluster Analysis↗
PubMed2000

Looking for change in response to the AIDS epidemic: trends in AIDS knowledge and sexual behavior in Zambia, 1990 through 1998.

This study investigates trends in AIDS knowledge and sexual behavior among men and women in urban Lusaka 1990 to 1998, and in all of Zambia, 1992 to 1998. Using data from representative surveys of urban Lusaka and of the country as a whole, population proportions were estimated to examine trends in knowledge and sexual risk behaviors. Differences in the estimated proportions between 1990 and 1998 were tested in Lusaka. In all Zambia, tests of difference were conducted between the earliest and latest years for which data were available for each indicator. A decline in premarital sexual activity was observed in urban Lusaka. In 1990, 50% of never married women reported no sexual experience, compared with 60% in 1998 (p =. 003); among men, the figures were 38% and 53%, respectively (p <. 001). Fewer women (1990, 8%; 1998, 2%; p <.001) and men (1990, 31%; 1998, 19%; p =.07) had extramarital partners. The bulk of change observed in urban Lusaka took place from 1990 to 1996; the changes in men's behavior observed between 1996 and 1998 were also observed in the national estimates for those years. National figures for other indicators from 1992 to 1998 were less encouraging. Apart from an increase in having ever used condoms, no change in women's sexual behavior was observed. Fewer men had premarital sex from 1996 to 1998 (1996, 64%; 1998, 46%; p <.001), but condom use with nonregular partners decreased among men (1996, 38%; 1998, 29%; p =.02). Prevention campaigns focused on education about AIDS and promoting safer sexual behavior appear to have made a difference in the early 1990s in Zambia. Findings from more recent years indicate that further change has stagnated. Renewed efforts are needed, particularly targeting condom use with nonregular partners.

Acquired Immunodeficiency Syndrome↗
PubMed2000

What husbands in northern India know about reproductive health: correlates of knowledge about pregnancy and maternal and sexual health.

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

Adolescent↗
PubMed1999

Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India.

Evidence to support that antenatal screenings and interventions are effective in reducing maternal mortality has been scanty and studies have presented contradictory findings. In addition, antenatal care utilization is poorly characterized in studies. As an exposure under investigation, antenatal care should be well defined. However, measures typically only account for the frequency and timing of visits and not for care content. We introduce a new measure for antenatal care utilization, comprised of 20 input components covering care content and visit frequency. Weights for each component reflect its relative importance to better maternal and child health, and were derived from a survey of international researchers. This composite measure for antenatal care utilization was studied in a probability sample of 300 low to middle income women who had given birth within the last three years in Varanasi, Uttar Pradesh, India. Results showed that demarcating women's antenatal care status based on a simple indicator--two or more visits versus less--masked a large amount of variation in care received. Logistic regression analyses were conducted to examine the effect of antenatal care utilization on the likelihood of using safe delivery care, a factor known to decrease maternal mortality. After controlling for relevant socio-demographic and maternity history factors, women with a relatively high level of care (at the 75th percentile of the score) had an estimated odds of using trained assistance at delivery that was almost four times higher than women with a low level of care (at the 25th percentile of the score) (OR = 3.97, 95% CI = 1.96, 8.10). Similar results were obtained for women delivering in a health facility versus at home. This strong positive association between level of care obtained during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.

Adolescent↗
PubMed1998

Husbands' reproductive health knowledge, attitudes, and behavior in Uttar Pradesh, India.

To enhance the reproductive health status of couples in developing countries, the knowledge, attitudes, and behavior of both women and men must be investigated, especially where women depend on men for the decision to seek care. This study analyzes data from a survey of 6,727 husbands from five districts in the northern state of Uttar Pradesh, India. Data are presented on men's knowledge of women's health and on their own sexual behavior outside the context of marriage, on their perceptions of sexual morbidity and their attempts at treatment for specific conditions, and on their opinions concerning the social role of wives. Findings indicate that men know little about maternal morbidity or sexual morbidity conditions. Few husbands reported that they had had sexual experience outside of marriage and the majority of these few said they had had such a relationship with more than one partner. Of men who said they had had reproductive morbidity symptoms, many said they had not sought treatment. Men's views concerning the role of wives indicate a low level of women's autonomy in this region of India. Results indicate a pressing need for reproductive health education that targets both women and men in Uttar Pradesh.

Adolescent↗