BackgroundDepression among women is common in developing countries. Gender inequality can contribute to women's risk for depression. Lack of reproductive and sexual rights is an important marker of gender inequality and women do not have the freedom to express their reproductive and sexual needs in many parts of the world. Therefore we designed this study to determine the association of depression with lack of various reproductive rights and domestic violence among married women in Karachi, Pakistan.MethodsA case-control study with 152 cases and 152 controls, which included women 15-48 years, recruited from two teaching hospitals from 1st June 2007 through 31st August 2007. The SRQ was administered to all subjects. A cut off score of 8 was used to confirm cases of depression diagnosed by physicians, and to exclude cases of depression from the controls. Self-administered questionnaire was used to assess the risk factors.Results61% of the cases and 43% of the controls were ever abused by spouse and the frequency of marital rape was 33% in cases and 13% in controls. After adjusting for the effects of other variables in the model, less than 18 years of age at marriage (OR 2.00; 95% CI = 1.07, 3.7), decision for marriage by parents (OR 3.51; 95% CI = 1.67, 7.37), abuse by in laws (OR 4.91; 95% CI = 2.66, 9.06), ≤ 3 hours per day spent with husband (OR 2.33; 95% CI = 1.34, 4.08), frequency of intercourse ≤ 2 times per week (OR 1.85; 95% CI = 1.06, 3.22) and marital rape (OR 3.03; 95% CI = 1.50, 6.11) were associated with depression among women.ConclusionIn our study depression in married women was associated with younger age at marriage, lack of autonomy in marriage decisions, marital rape and domestic abuse by in-laws. Efforts should be directed towards creating awareness about the reproductive and sexual rights of women in Pakistan. Physicians should be trained to screen and identify women who may be at risk for psychological distress as a result of denial of reproductive rights so that they can support positive mental health outcomes through individual, family or marital counseling.

Good governance and a conducive organizational culture are important prerequisites for incorporating any new project within an existing system. This includes prior consensus building among all stakeholders, a meaningful and inclusive participatory planning, implementation and evaluation process involving communities, political commitment, and the identification and use of appropriate leadership for project management.

SummaryOBJECTIVES Severe economic crisis compelled many governments in Sub-Saharan Africa to adopt structural adjustment programmes. This was accompanied by price increases and cuts in the salaries of civil servants. We explored how health personnel in one province of Cameroon coped with this situation, and what the perceived effects on service quality were. METHODS Key informant and focus group interviews with government and mission (church) health personnel; interviews with service users to validate the findings. RESULTS Government health personnel had experienced larger cuts in salaries than their mission counterparts; they no longer received allowances and incentives still available to mission personnel and appeared more demotivated. Most government and mission personnel reported legal after-hours income raising activities. Government personnel frequently reported additional 'survival strategies' such as parallel selling of drugs, requesting extra charges for services, and running private practices during work hours. There was a high level of self criticism among government personnel indicating a dissonance between their attitude and practices. They considered these practices negative and harmful for service users. CONCLUSION Remedial action is urgent. Options include reinstating allowances for good performance and ensuring regular supervision without blaming individual health workers for problems caused by the state of the health system. keyword structural adjustment programme, sub-Saharan Africa, health services, Cameroon correspondence Dr Oliver Razum, Abteilung für Tropenhygiene, Universität Heidelberg, Im Neuenheimer Feld 324,

Unsupervised cross-domain image-to-image translation is a very active topic in computer vision and graphics. This task has two challenges: 1) lack of paired training data and 2) numerous possible outputs from a single image. The existing methods rely on either paired data or perform one-to-one translation. A novel Multi-Style Unsupervised image synthesis model using Generative Adversarial Nets (MSU-GAN) is proposed in this paper to overcome these disadvantages. Firstly, the encoder-decoder structure is used to map the image to domain-shared content features space and domain-specific style features space. Secondly, to translate an image into another domain, the content code and the style code are combined to synthesize the resulting image. Finally, the bidirectional cycle-consistency loss is used for the unpaired training data; the inter-domain adversarial loss and the reconstruction loss are used to ensure the output image's realism. Simultaneously, MSU-GAN is able to synthesize multi-style images due to disentangled representation. A Multi-Style Unsupervised Feature-Wise image synthesis model using Generative Adversarial Nets (MSU-FW-GAN) based on the MSU-GAN is proposed for the shape variation tasks. There are two different testing strategies, which include random style transfer and style guide transfer. For objective comparison, the proposed model performs well on all evaluation metrics. The random style transfer experiment results show that compared with CycleGAN on the photo2portraits dataset, MSU-FW-GAN FID, IS scores dropped by 12.77% and 8.06%. For the summer2winter dataset, MSU-GAN FID and IS scores increased by 24.51% and 3.64%. Qualitative results show that without paired training data, MSU-GAN and MSU-FW-GAN can synthesize multi-style and better realistic images on various tasks.