Search

Longitudinal diary data gathered over 15 months were used to investigate the influence of individual sociodemographic factors and the circumstances of sexual contacts on condom use among a cohort of prostitutes in the Gambia. A cohort of 181 prostitutes working in 7 bars and several rural markets were monitored daily for 14 months. A sample of 747 clients of these prostitutes was questioned during March 1989-May 1990. Crude and location-standardized condom-use ratios were calculated for each woman. Among the 24181 recorded sexual contacts condom use was reported for 84% of the 22916 contacts with clients and 4% of the 1265 contacts with regular partners. Condom use with clients varied according to location (from 91% in high-class bars to 59% in rural markets) decreased from 91% with the first client of the evening to 37% with the tenth client and from 75% with clients paying higher charges to 52% with those paying lower charges. There were no significant associations between condom use and age level of education marital status country of origin use of other contraceptives number of children or whether or not the prostitute had a regular partner. Questionnaire data collected from the 747 clients after a sexual contact showed that the clients level of education was significantly related to condom use increasing from 56% among those with no education to 81% among those with tertiary education. There was no significant relationship between condom use and marital status ethnic group or country of origin. Comparisons of client and prostitute reports showed agreement in condom use for 76% f contacts but in 22% of cases the client reported not using a condom while the prostitute reported the opposite. Clients aged 20-24 years were least likely to use condoms; white collar workers traders and those paying higher charges were more likely to use condoms.

This study is based on interviews conducted among 8 women's income-generating groups and 12 individual women entrepreneurs in 15 villages in Masaka district, Uganda. The Baganda are the main tribe in the study villages. The study evaluates the economic achievement, objectives, and social characteristics of the groups. Groups ranged in size from 9-20 members. All had functioned for 3-5 years. A regular membership fee was paid through the sale of agricultural produce. Groups met at least every 2 weeks. This study revealed that the individual goals were to increase individual wealth, while the stated group goals were to invest in the community. Members considered the groups as useful in providing an easy way to raise capital. Most members considered financial status as a criterion for group membership. Elderly women tended to join social and handicraft groups. The women's group members tended to be friends before the establishment of the group and tended to be currently married to men residing in the area. Of the 12 women entrepreneurs, only 5 were currently married. All 12 women entrepreneurs had considerable initiative. The 12 women and the women's group members derived income from two or more sources: agricultural projects, animal husbandry, craft production, alcohol production and sale, or other activities. Study findings indicate that decisions were often delayed or avoided in order to preserve social cohesion. In a market-oriented enterprise, quick response time is needed and the bureaucratic dynamics would hinder some agricultural ventures. The poorest women experienced barriers to group membership. Women entrepreneurs were more successful than group women.

A simple and inexpensive method for monitoring child mortality in association with birth registration was introduced into the Southern Highlands of Papua New Guinea. Eight thousand two hundred and one newborn infants were registered in 1988, approximately 77% of all children born in that year. The risk of death by age 2 was determined from reports given by the mother on the present status of a previously born child at the time of a recent delivery or during clinic registration of the current birth. This was 91 per 1000 for the province and corresponds to a risk of death by age 1 of 77/1000 by extrapolation using standard lifetables. This method was validated by comparison with a continuing demographic surveillance system covering 30,000 people in the western part of the province. The new birth certificate has been an incentive to increase supervised delivery rates and to generate a register that can be used to increase vaccination coverage.The successful experience with the newly established birth registration system in the Southern Highlands Province of Papua New Guinea is presented. The methods of data collection, the practical problems encountered, and the registration, mortality rate, and birth interval results for 1988 are discussed. Problems involved some maternal-child health (MCH) clinic teams being late in giving out birth certificates or not giving certificates at all during 1988. Registration was 77%. Other irregularities included giving certificates before the January 1 start-up or after infants reached their 1st birthday. 98% of registrations were made within the 1st month of birth. Clinic registrations exceeding 100% were due to mothers crossing over district boundaries to use a clinic closer to home, migration, variability of population growth, and underenumeration in the 1980 census. Children born and dying before the 1st clinic visit were not recorded. This province has the highest infant and child mortality rates in all Papua New Guinea. Before 1988, the Tari research unit (TRU) collected demographic data on the Huli language group, which showed that birth data could be collected and child mortality estimated from mother's reports. The certificate was designed to be desirable by mothers. The mortality method of estimating the probability of dying by 2 years involved the tabulation of previous child deaths reported by mothers at the time of birth registration and calculating the ratio of child deaths reported to the number of mothers reporting a previous birth. The retrospective data refer to the period approximately 2/3 of the mean birth interval prior to the date of birth registration collection. Estimates of infant mortality were made using the Coale-Demeny standard life table model. 8201 birth certificates were registered out of the estimated 10,611 births of which 51% were males. 79% (6510) of mothers reported a previous birth of which 592 were dead. The risk of dying by 2 years corresponds to 91/1000 for 1986 with an infant mortality rate of 77/1000. Mothers whose current child was born at a health center had a higher level of mortality (103) for the previous child than mothers whose recent child was born without supervision (81). The mean birth interval was estimated at 40.8 months for Tari district, which is probably overestimated. 62% of 1st time mothers had supervised deliveries. Comparisons are made with TRU data which showed a reversal of results for supervised vs. unsupervised deliveries.

A longitudinal study of the sexual behaviour of high-risk men and women living in a trading town on the trans-Africa highway showed that distinct sexual networks operated within the town. Forty-eight prostitutes kept daily records for 6 months of all their sexual contacts including the occupation and place of residence of each client and the price paid. Details of 4573 sexual contacts of the women were recorded. Three classes of women were identified: (1) 20 "high-class' women who charged a mean price of over US $4/- per contact. The majority of their clients were from large urban areas of Uganda (55%) or neighbouring countries (32%)-70% were truck-drivers or their mates; (2) 18 "low-class' women, charging an average of US $0.4 per contact, who were patronized predominantly by men resident in the town (71%) who were unskilled casual workers (58%); (3) 10 women fell into an intermediate category in terms of price and the residence of their clients. Thirty-eight male potential clients were recruited in low-cost bars where some of the women worked. They provided similar details of their daily sexual contacts. All were resident in the town and 22 had occupations which were classified as unskilled. Of the 1621 sexual contacts recorded by the men 25% were with new partners.A longitudinal study of the sexual behavior of men and women living in a trading town on the trans-Africa highway (100 km south-west of Kampala, Uganda) revealed the presence of distinct networks of casual and commercial sex. 48 commercial sex workers recruited from bars and hotels on or away from the main road and 38 potential male clients located in bars away from the road were followed for a mean period of 16 and 13 weeks, respectively. Among women, a total of 4573 sexual contacts were recorded over 787 woman-weeks of observation, for an average of 5.8 contacts per week; 472 contacts (10%) were with regular partners. Condoms were reportedly used in 99% of casual and 59% of regular contacts. Clients of high-class prostitutes (charging over US$4/contact) were generally drivers from other urban areas or neighboring countries, while those of middle-class sex workers (US$2/contact) tended to be from fishing villages and those of low-class sex workers (under US$0.50/contact) were predominantly local unskilled workers. Among male respondents, 1621 sexual contacts were reported during 516 man-weeks of observation, for an average of 3.1 contacts per week; 584 contacts (36%) were with regular partners and 406 (24%) were with new partners. Men reported condom use in 3% of regular contacts and 87% of casual contacts. In-depth interviews with a convenience sample of six men revealed a total of 32 sexual contacts in the previous 2 weeks, of which eight involved wives or regular partners, 11 were with a sex worker encountered in discos or on the road, and 13 were with a woman known for 2-3 days. The condom use rates reported by respondents for casual partners are considered inflated, especially in light of the drunkenness that usually accompanies sexual encounters initiated in lower-class bars.

This study investigates the relationship between social and environmental variables and diarrhoea and growth in children aged between 6 and 36 months in an urban area of The Gambia, West Africa. The social and environmental conditions of 493 children were observed and recorded over a period of 12 months. Two hundred and seventy-seven children were under weekly diarrhoea surveillance for a 15 week period during the wet season and 322 children had anthropometric measurements taken in May and September. Computer analysis was used to determine association between single and multiple environmental and social factors and diarrhoea prevalence and growth. The results of the diarrhoea surveillance showed that there was considerable variation between individual children. Thirty children had no diarrhoea during the period of surveillance and 30 had diarrhoea for over 24% of the time, with 2 children having diarrhoea for more than 50 days out of a total of 105. None of the social and environmental variables recorded showed a significant relationship with diarrhoea prevalence. The anthropometric measurements showed that at the end of the wet season, in September, 23% of children in this age group were less than 90% of the National Centre for Health Statistics standards of height for age and several of the variables recorded showed a statistically significant association with this measurement.

To determine the effect of counselling on condom use by prostitutes.Cohort study.Field-based study in The Gambia.Thirty-one (12 HIV-positive and 19 HIV-negative) prostitutes.Post-test HIV counselling.Levels of condom use.Overall, counselling had no effect on condom use.Scarce resources should be directed towards providing condoms in bars rather than counselling.HIV infection is much more prevalent in prostitution than in the general population of the Gambia (26.2 vs. 1.7%, respectively, in 1988). The short-and long-term effects of counseling on condom use by prostitutes was examined by determining condom use in 29 prostitutes, 11 HIV-positive (group 1) and 18 HIV-negative (group 2), before and 1 month after counseling and in 31 prostitutes, 12 HIV-positive group 3) and 19 HIV-negative (group 4), before and 2-5 month after counseling. HIV-positive women were told that reinfection would increase their chances of developing AIDS as well as lead to transmission of the virus. 3515 sexual contacts were recorded before counseling, 1252 after 1 month, and 4949 at 2-5 months later. Group 1 women reported an 89.3% rate of use before counseling; 1 month later, 9 maintained their rate, 1 increased use from 56 to 81%, and 1 decreased use from 31 to 26%. Group 2 women had 88% use before and, in 11 of the 12 women, 90% use after counseling; the 12th woman reduced use to 66% and was observed to increase her alcohol intake significantly. In both groups, 4 increased use and 3 reduced use. In Group 3, condom use declined insignificantly from 89.3 to 83.5%. 4 women maintained 90% use, 6 reduced use, and 2 increased it. Group 4 women decreased use insignificantly from 88% before to 84.4% after counseling. 8 women maintained original levels of use, 4 increased, and 7 decreased (1 from 90% to as low as 17%). In groups 3 and 4, 74% had 90% use precounseling; this fell to 69% at 1 month and 36% at 2-5 months after counseling, a significant decrease in usage. In all of the prostitutes, condom use increased in the first month after counseling and fell 2-5 months later. Counseling, therefore, failed to increase overall condom use. Possible reasons for this failure include the Senegalese backgrounds of many of the women (they were accustomed to health checks and free condoms); the low number of AIDS deaths in the Gambia, which keeps the disease a distant possibility instead of a pressing reality for the prostitutes; and the consideration of condom use as primarily a method to prevent contraction of the traditional sexually transmitted diseases. When resources are scarce, it may be more important to provide free condoms in bars frequented by prostitutes than to provide counseling.