In sub-Saharan Africa, HIV prevalence does not exhibit the same pattern of association with poverty as most other diseases. HIV programmes should also focus on the wealthier segments of the population.

Objective: To explore how sexual and marital trajectories are associated with HIV infection among ever-married women in rural Malawi. Methods: Retrospective survey data and HIV biomarker data for 926 ever-married women interviewed in the Malawi Diffusion and Ideational Change Project were used. The associations between HIV infection and four key life course transitions considered individually (age at sexual debut, premarital sexual activity, entry into marriage and marital disruption by divorce or death) were examined. These transitions were then sequenced to construct trajectories that represent the variety of patterns in the data. The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region. Results: Although each life course transition taken in isolation may be associated with HIV infection, their combined effect appeared to be conditional on the sequence in which they occurred. Although early sexual debut, not marrying one's first sexual partner and having a disrupted marriage each increased the likelihood of HIV infection, their risk was not additive. Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive. Women who marry their first partner but who have sex at a young age, however, are also at considerable risk. Conclusions: These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one's life. The analysis suggests, however, the need for further data collection to permit a better examination of the mechanisms that account for variations in life course trajectories and thus in lifetime probabilities of HIV infection.With the development of life course epidemiology 1 and sequence analysis in demographic research, 2 increasing attention has been given to the impact of early life experiences on adult health. This approach has the potential to be useful for studying the AIDS epidemic because the temporal ordering and timing of individuals' sexual and marital partnerships may be quite relevant for one's lifetime risk of contracting a sexually transmitted infection. 3Most previous research has focused on the relationship between a single transition and HIV infection. Several studies have shown, for example, that early sexual debut is associated with an increased likelihood of HIV infection. [4][5][6] The time between first sex and first marriage, as well as the number of premarital sexual partners, are also both believed to increase the HIV risk substantially. 7The transition into marriage itself influences HIV risks: women who marry before the age of 20 are more likely to be HIV-positive than unmarried women of the same age, both because marriage typically coincides with a dramatic increase in the frequency of s...

BackgroundAlthough the relationship between self-rated health (SRH) and physical and mental health is well documented in developed countries, very few studies have analyzed this association in the developing world, particularly in Africa. In this study, we examine the associations of SRH with measures of physical and mental health (chronic diseases, functional limitations, and depression) among adults in Ouagadougou, Burkina Faso, and how these associations vary by sex, age, and education level.MethodsThis study was based on 2195 individuals aged 15 years or older who participated in a cross-sectional interviewer-administered health survey conducted in 2010 in areas of the Ouagadougou Health and Demographic Surveillance System. Logistic regression models were used to analyze the associations of poor SRH with chronic diseases, functional limitations, and depression, first in the whole sample and then stratified by sex, age, and education level.ResultsPoor SRH was strongly correlated with chronic diseases and functional limitations, but not with depression, suggesting that in this context, physical health probably makes up most of people’s perceptions of their health status. The effect of functional limitations on poor SRH increased with age, probably because the ability to circumvent or compensate for a disability diminishes with age. The effect of functional limitations was also stronger among the least educated, probably because physical integrity is more important for people who depend on it for their livelihood. In contrast, the effect of chronic diseases appeared to decrease with age. No variation by sex was observed in the associations of SRH with chronic diseases, functional limitations, or depression.ConclusionsOur findings suggest that different subpopulations delineated by age and education level weight the components of health differently in their self-rated health in Ouagadougou, Burkina Faso. In-depth studies are needed to understand why and how these groups do so.

Self-reports of HIV infection were generally valid. Most invalid self-reports were due to overestimating the risk of having HIV. The implications of this finding are highlighted, as they pertain to the design of HIV prevention interventions and the expansion of HIV counselling, testing and treatment programmes in developing countries.

AIDS-related morbidity and mortality are expected to have a large economic impact in rural Malawi, because they reduce the time that adults can spend on production for subsistence and on income-generating activities. However, households may compensate for production losses by reallocating tasks among household members. The data demands for measuring these effects are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of qualitative and quantitative data, including biomarkers for HIV, collected by the 2004 Malawi Diffusion and Ideational Change Project, to analyze the association between AIDS-related morbidity and mortality, and time allocation decisions in rural Malawian households. We find that AIDS-related morbidity and mortality have important economic effects on women’s time, whereas men’s time is unresponsive to the same shocks. Most notably, AIDS is shown to induce diversification of income sources, with women (but not men) reallocating their time, generally from work-intensive (typically farming and heavy chores) to cash-generating tasks (such as casual labor).

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The need for accurate statistics has never been felt so deeply as the novel COVID-19 pathogen spreads around the world and quantifying its severity is a primary clinical and public health issue. In Italy, the magnitude and increasing trend of the case-fatality risk (CFR) is fueling the already high levels of public alarm. In this paper, we highlight that the widely used crude CFR is an inaccurate measure of the disease severity since the pandemic is still unfolding. With the goal to improve its comparability over time and across countries at this stage, we then propose a demographic adjustment of the CFR that addresses the bias arising from differential case ascertainment by age. When applied to publicly released data for Italy, we show that until March 16 our adjusted CFR was similar to that of Wuhan -the most affected Chinese region, where COVID-19 has now been contained. This indicates that our adjusted CFR improves its comparability over time, making an important tool to chart the course of the COVID-19 pandemic across countries. Since March 16, the Italian COVID-19 outbreak has entered a new phase, with the northern and southern regions following different trajectories. As a result, our adjusted CFR has been increasing between March 16 and March 20. Data at the subnational level are needed to correctly assess the disease severity in the country at this stage. SOMMARIOIl diffondersi dell'epidemia COVID-19 ha dimostrato l'importanza di un'informazione corretta, laddove la mancanza di una risposta tempestiva si valuta essenzialmente in termini di vite umane. In Italia, la propagazione del COVID-19 è stata accompagnata da un'informazione imprecisa circa la sua reale entità e gravità. In questo contributo, dimostriamo come il tasso di fatalità, attualmente l'indicatore più utilizzato della severità del virus, sia inaccurato a questo stadio della pandemia e proponiamo un metodo demografico per migliorarne la stima, in particolare durante la fase ascendente della curva epidemica. L'applicazione del nostro metodo ai dati nazionali italiani dimostra che, fino al 16 di Marzo, il tasso di fatalità rimane assimilabile a quello osservato nella regione di Wuhan, ma comincia a conoscere un drastico incremento negli ultimi giorni. I nostri risultati indicano che il metodo proposto migliora la comparabilità del tasso di fatalità nel tempo e tra paesi, dimostrando la sua utilità come strumento per tracciare e comprendere l'evoluzione pandemica attuale.

Intimate partner violence (IPV) is a pressing international public health and human rights concern. Recent scholarship concerning causes of IPV has focused on the potentially critical influence of social learning and influence in interpersonal interaction through social norms. Using sociocentric network data from all individuals aged 16 years and above in a rural Senegalese village surveyed as part of the Niakhar Social Networks and Health Project ( n = 1,274), we estimate a series of nested linear probability models to test the association between characteristics of respondents’ social networks and residential compounds (including educational attainment, health ideation, socioeconomic status, and religion) and whether respondents are classified as finding IPV acceptable, controlling for individual characteristics. We also test for direct social learning effects, estimating the association between IPV acceptability among network members and co-residents and respondents’ own, net of these factors. We find individual, social network, and residential compound factors are all associated with IPV acceptability. On the individual level, these include gender, traditional health ideation, and household agricultural investment. Residential compound-level associations are largely explained in the presence of the individual and network characteristics, except for that concerning educational attainment. We find that network alters’ IPV acceptability is strongly positively associated with respondents’ own, net of individual and compound-level characteristics. A 10% point higher probability of IPV acceptability in respondents’ networks is estimated to be associated with a 4.5% point higher likelihood of respondents being classified as finding IPV acceptable. This research provides compelling evidence that social interaction through networks exerts an important, potentially normative, influence on whether individuals in this population perceive IPV as acceptable or not. It also suggests that interventions targeting individuals most likely to perceive IPV as acceptable may have a multiplier effect, influencing the normative context of others they interact with through their social networks.