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The objective of this study was to examine stillbirth risk by nativity and Hispanic ethnicity. We analyzed births and fetal deaths among women of Hispanic origin within gestational ages of 20-42 weeks from the 2014-2019 Birth and Fetal Death. Foreign-born Hispanic mothers were 8% less likely (HR 0.92, 95% CI 0.90-0.95) to experience stillbirth than their counterparts. Stratified by ethnicity, foreign-born Mexican and Central/South American women had a lower risk of stillbirth (HR 0.85, 95% CI 0.81-0.88 and HR 0.68, 95% CI 0.63-0.75, respectively) while foreign-born Puerto Rican women were more likely to experience stillbirth (HR 1.37, 95% CI 1.24-1.51) than their native-born counterparts. While overall foreign-born Hispanic mothers were less likely to experience stillbirth than native-born Hispanic mothers, this differed depending on ethnicity. Counseling regarding risk of stillbirth among Hispanic women should take into consideration nativity and country of origin as influential factors.

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STUDY OBJECTIVE: In the present study we investigated the association between receiving information on sexual literacy topics and likelihood of experiencing adolescent pregnancy. DESIGN: Cross-sectional analysis. SETTING: Colombia. PARTICIPANTS: Female Adolescents, 13-19 years old (N = 8525). MAIN OUTCOME MEASURES: Our primary outcome of interest was adolescent pregnancy. RESULTS: We created a gradation of public health impact variable that ranged from grade 1 (least impactful) to grade 4 (most impactful) to determine which sexuality-related topics were most strongly associated with teenage pregnancy. We found that not receiving information on grade 4 topics had the strongest association with adolescent pregnancy. These topics were: changes related to puberty (prevalence ratio [PR], 2.15; 95% confidence interval [CI], 1.40-3.30), how sex organs work (PR, 1.90; 95% CI, 1.37-2.66), and sexual orientation (PR, 1.84; 95% CI, 1.38-2.44). In fact, teenagers who did not receive information on any sexuality-related topic were approximately 75% more likely (PR, 1.73; 95% CI, 1.09-2.74) to experience pregnancy during adolescence. CONCLUSION: The gradation levels of this study could guide sexual education programs in Colombia to prioritize sexuality-related themes, especially when resources are limited.

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OBJECTIVE: To investigate the association of socioeconomic status (SES) components (education, occupation, and household wealth) with number (1 or ≥2) and timing (planned/emergency) of cesarean delivery (CD) in Colombia, rates of which are well above the levels recommended by the World Health Organization. METHODS: A cross-sectional study using the 2015 Demographic and Health Survey (DHS) of Colombia was carried out; 38 718 women answered the woman only module. Binomial and multinomial logistic regression analyses were conducted to generate estimates of the association between markers of SES and likelihood of CD, timing of CD, and number of CDs. RESULTS: The analysis included 9977 women. Although education and wealth were strongly associated with CD (P<0.001), the association between occupation and CD suggested that women in agriculture were the least likely to experience CD (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.44-1.03, P=0.061); and women in the "poorer" household wealth category were more likely to have emergency (OR 1.57, CI 1.29-1.90, P<0.001) and two or more (OR 1.64, CI 1.29-2.40, P<0.001) CDs. CONCLUSION: Markers of SES are associated with CD overuse in Colombia, as well as the number and timing of CD. More robust qualitative inquiry including additional questions to the DHS survey are needed to elucidate reasons driving the overutilization of CD in the country, particularly among vulnerable populations.

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OBJECTIVE: To assess the association between intimate partner violence (IPV) and pregnancy termination in Latin America. METHODS: Demographic and Health Survey (DHS) data were analyzed for Honduras, the Dominican Republic, Colombia, Peru, and Guatemala. Women were asked about their experiences with violence by partners and pregnancy termination. The association between IPV and risk for termination was assessed using adjusted odds ratios (OR) with correction for intracluster correlations. RESULTS: The average prevalence of IPV across the five countries was 31.8%. Women who reported IPV had 1.4 times the odds of experiencing pregnancy termination OR 1.41 (95% CI, 1.32-1.50). A positive dose-response relationship was observed between IPV and termination; a woman who reported three types of IPV showed three times the odds of experiencing pregnancy termination compared with a woman who did not report IPV. Elimination of exposure to IPV in all five countries was associated with 167 743 fewer pregnancy terminations. CONCLUSION: IPV is a risk factor for pregnancy termination. Reduction or elimination of IPV is associated with substantial decline in pregnancy terminations in Latin America. Routine prenatal screening for IPV and counseling could potentially avert a substantial number of pregnancy terminations in these settings.

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A recent major earthquake (M7.8), coupled with appropriate climatic conditions, led to significant destruction in Ecuador. Temperature variations, which may be induced by anthropogenic climate change, are often associated with changes in rainfall, humidity and pressure. Temperature and humidity are associated with ecological modifications that may favour mosquito breeding. We hypothesized that the disruptive ecological changes triggered by the earthquake, in the context of appropriate climatic conditions, led to an upsurge in Zika virus (ZIKV) infections. Here we show that, after controlling for climatic and socioeconomic conditions, earthquake severity was associated with incident ZIKV cases. Pre-earthquake mean maximum monthly temperature and post-earthquake mean monthly pressure were negatively associated with ZIKV incidence rates. These results demonstrate the dynamics of post-disaster vector-borne disease transmission, in the context of conducive/favourable climatic conditions, which are relevant in a climate change-affected world where disasters may occur in largely populated areas.

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There is a reemergence of syphilis in the Latin American and Caribbean region. There is also very little information about HIV/Syphilis co-infection and its determinants. The aim of this study is to investigate knowledge, attitudes, and practices regarding sexually transmitted infections (STIs), in particular syphilis infection and HIV/Syphilis co-infection, as well as to estimate the prevalence of syphilis among men who have sex with men (MSM) in a city with one of the highest HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 291 adult MSM. Questions included knowledge about STIs and their sexual practices. Blood samples were taken from participants to estimate the prevalence of syphilis and HIV/syphilis co-infection. In this population, the prevalence of HIV/syphilis co-infection was 4.8%, while the prevalence of syphilis as mono-infection was 6.5%. Participants who had syphilis mono-infection and HIV/syphilis co-infection were older. Men who had multiple partners and those who were forced to have sex had increased odds of syphilis and HIV/syphilis co-infection. A high prevalence of syphilis and self-reported STI was observed, which warrants targeted behavioral interventions. Co-infections are a cause for concern when treating a secondary infection in a person who is immunocompromised. These data suggest that specific knowledge, attitudes, and behaviors among MSM are associated with increased odds of STIs (including HIV/syphilis co-infections) in this region of Ecuador.

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The Joint United Nations Program on HIV/AIDS estimates that between 0.3% and 0.7% of adults aged 15 to 49 years were living with HIV in Ecuador in 2013. However, very little is known about the HIV prevalence rate among men who have sex with men (MSM) in that country. A cross-sectional survey was conducted to investigate the knowledge, attitudes, and practices regarding HIV/AIDS as well as to estimate the prevalence of HIV among MSM in one of the cities with high HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 307 adult MSM. An HIV prevalence of 10% was observed. Knowledge about HIV was high; 91% of participants could identify how HIV is transmitted. Although consistent condom use for anal sex was relatively high (89%) among participants who reported having pay-for-service clients, only 64% reported using a condom during oral sex with a client. Participants who had multiple male sexual partners (i.e., their stable male partners plus other partner[s]) had 3.7 times higher odds of testing positive for HIV compared with those who did not. They also had reduced odds of condom use. Participants who were forced to have anal receptive sex had 3 times higher odds of testing positive for HIV. Despite the finding that participants exhibited high knowledge about HIV/AIDS, a high prevalence rate of HIV was observed, which warrants targeted behavioral interventions. These data are consistent with MSM being one of the highest at-risk population groups for HIV in this region of Ecuador.

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The use of condoms can reduce the risk of sexually transmitted infections (STIs) including the human immunodeficiency virus (HIV) infection. We conducted this study to determine factors that impact condom use among patients attending an STI clinic in Montego Bay, Jamaica. A questionnaire containing sections on socio-demographic characteristics, knowledge of STIs and HIV, preventive measures for STI/HIV transmission and sexual practices including condom use was administered to 212 participants. Using logistic regression, we determined the relationship between the different factors and condom use during the last sexual episode. Approximately 43% of study participants reported condom use during the last sexual episode. Employment (OR=2.2; 95%CI=1.1-4.1) and greater knowledge of STIs (OR=1.9, 95%CI=1.02-3.6) were associated with increased likelihood of condom use during the last sexual episode. Having multiple sexual partners was associated with decreased likelihood to report condom use (OR=0.3, 95%CI=0.1-0.9). Also, persons belonging to a religious organization were less likely to report condom use (OR=0.5, 95%CI=0.2-0.9). The results of this study can be used in formulating effective strategies to increase condom use in Montego Bay. This would decrease the transmission of STIs and HIV.

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OBJECTIVE: To clarify the association between childhood pregnancy and risk of stillbirth. STUDY DESIGN: We analyzed singleton and twin pregnancies that occurred in children (10-14 years old) in the United States from 1989 to 2000. We estimated the absolute and relative risks of stillbirth by using 15- to19-year-old and 20- to 24-year-old mothers as comparison groups. RESULTS: The analysis involved 17.8 million singletons and 337,904 individual twins. The rate of stillbirth was highest in pediatric mothers for both singletons (12.8/1000) and twins (56/1000) compared with adolescent (6.8/1000 in singletons and 29/1000 in twins) and mature (5.5/1000 in singletons and 20/1000 in twins) mothers. After adjusting for confounding characteristics, pediatric mothers continued to exhibit significantly elevated risk for stillbirth in both singletons (odds ratio, 1.57; 95%CI, 1.49-1.66) and twins (odds ratio, 1.97; 95%CI, 1.42-2.73). Preterm birth rather than small size for gestational age was revealed by means of sequential modeling to account for the excess risk of stillbirth observed in pediatric gravidas. CONCLUSION: Pregnancy in childhood is a risk factor for stillbirth; shortened gestation rather than reduction in fetal growth is the mediating pathway.

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BACKGROUND: A large number of mothers may not be practicing exclusive breastfeeding in rural Jamaica, although no recent systematic study has been conducted. The impact of knowledge about and attitude toward breastfeeding on the duration of exclusive breastfeeding is also poorly understood. The objective of this study was to gather information about factors that influence exclusive breastfeeding and its duration. METHOD: A cross-sectional study was conducted in 11 health centers within the parish of Saint Ann, Jamaica. A pretested questionnaire collected information on breastfeeding knowledge and attitudes toward intention to breastfeed and other relevant sociodemographic characteristics. RESULTS: Information was documented for 599 mother-child pairs. The prevalence of breastfeeding initiation was 98.2 percent; of mothers who initiated breastfeeding, 22.2 percent practiced it exclusively (at least 6 months). No difference occurred between exclusive and nonexclusive breastfeeding mothers in terms of knowledge about and attitudes toward breastfeeding. Of potential predictors assessed, the male partner's role as the main source of income for the family was the only significant predictor for exclusive breastfeeding. Women whose male partner was the main source of income for the family were twice as likely to exclusively breastfeed their infants compared with the referent group (mothers as main source of income)(OR=2.0; 95% CI=1.4-3.0). In addition, the dominant reason for partial breastfeeding was maternal anxiety that breastmilk alone might not provide sufficient nourishment. CONCLUSION: The level of exclusive breastfeeding was extremely low at the study site. Formulation of strategies to aggressively promote exclusive breastfeeding practices is urgently needed there. Such interventions should consider involvement of the male partner, especially, with respect to the financial support, as well as alleviating maternal anxiety regarding nutritional adequacy of breastmilk.

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