Congenital diaphragmatic hernia presenting with symptoms within the first day of life; outcomes from a non-ECMO centre in Denmark.

BACKGROUND: Between 1998 and 2015, we report on the survival of congenital diaphragmatic hernia (CDH)-infants presenting with symptoms within the first 24 h of life, treated at Odense University Hospital (OUH), a tertiary referral non-extracorporeal membrane oxygenation (ECMO) hospital for paediatric surgery. METHODS: We performed a retrospective cohort study of prospectively identified CDH-infants at our centre. Data from medical records and critical information systems were obtained. Baseline data included mode of delivery and infant condition. Outcome data included 24-h, 28-day, and 1 year mortality rates and management data included intensive care treatment, length of stay in the intensive care unit, time of discharge from hospital, and surgical intervention. Descriptive analyses were performed for all variables. Survivors and non-survivors were compared for baseline and treatment data. RESULTS: Ninety-five infants were identified (44% female). Of these, 77% were left-sided hernias, 52% were diagnosed prenatally, and 6.4% had concurrent malformations. The 28-day mortality rate was 21.1%, and the 1 year mortality rate was 22.1%. Of the 21 non-survivors, nine died within the first 24 h, and 10 were sufficiently stabilised to undergo surgery. A statistically significant difference was observed between survivors and non-survivors regarding APGAR score at 1 and 5 min., prenatal diagnosis, body length at birth, and delivery at OUH. CONCLUSIONS: Our outcome results were comparable to published data from other centres, including centres using ECMO.

Quality of life in congenital diaphragmatic hernia survivors treated at a non-ECMO centre from 1998 to 2015: a cross-sectional study.

BACKGROUND: Survival of infants with congenital diaphragmatic hernia (CDH) has increased and more insight is warranted on the long-term issues of this condition. METHODS: We conducted a cross-sectional study on consecutively born infants with CDH treated at a non-extracorporeal membrane oxygenation centre (ECMO) from 1998 to 2015. Quality of life was evaluated using the Pediatric Quality of Life Inventory Generic Core Scale 4.0 (PedsQL(4.0)) Questionnaire and an interview was conducted to assess for CDH-related morbidity. RESULTS: 71 eligible CDH survivors were identified and 51 consented to participate: aged 5-21 years, 28 (54.9%) male, 42 (82.4%) with left-sided hernias, 10 (19.6%) needed patch repair, median length of stay in hospital was 27.96 days (IQR 18.54-61.56). Forty-nine completed the questionnaire with a median PedsQL total score for participants of 82.6 vs 83.7 of the total proxy parent score (p=0.04). Total score was significantly lower for participants aged 5-12 years compared with participants aged 13-21 years (p=0.04); however, when reported by domains, only the physical score remained significantly lower (p=0.048). Two (4.1%) participants' and 8 (16.7%) proxy parents' scores were below 70 and considered at risk of impaired quality of life. We identified the presence of CDH-related morbidity in our population, and confirmed an association between respiratory morbidity and lower PedsQL scores (p=0.04). CONCLUSION: We report an overall good quality of life in our population with CDH. However, a lower physical score was noted when compared with a national Danish cohort and individuals at risk of reduced quality of life were recognised. Structured follow-up programmes to identify and ensure early management of CDH-related issues may prevent a negative impact on quality of life.

A comparative study of varying doses of enoxaparin for thromboprophylaxis in critically ill patients: a double-blinded, randomised controlled trial.

INTRODUCTION: Critically ill patients are predisposed to venous thromboembolism. We hypothesized that higher doses of enoxaparin would improve thromboprophylaxis without increasing the risk of bleeding. Peak anti-factor Xa (anti-Xa) levels of 0.1 to 0.4 IU/ml reflect adequate thromboprophylaxis for general ward patients. Studies conducted in orthopaedic patients demonstrated a statistically significant relationship between anti-Xa levels and wound haematoma and thrombosis. Corresponding levels for critically ill patients may well be higher, but have never been validated in large studies. METHODS: Eighty critically ill patients weighing 50 to 90 kilograms were randomised in a double-blinded study to receive subcutaneous (sc) enoxaparin: 40 mg once daily (QD), 30 mg twice daily (BID), 40 mg BID, or 1 mg/kg QD, each administered for three days. Anti-Xa activity was measured at baseline, and daily at 4, 12, 16 and 24 hours post administration. Antithrombin, fibrinogen, and platelets were measured at baseline and twice daily thereafter. RESULTS: Two patients were transferred prior to participation. On day 1, doses of 40 mg QD (n = 20) and 40 mg BID (n = 19) yielded mean peak anti-Xa of 0.20 IU/ml and 0.17 IU/ml respectively. A dose of 30 mg BID (n = 20) resulted in much lower levels (0.08 IU/ml). Patients receiving 1 mg/kg QD (n = 19) achieved near steady-state mean peak anti-Xa levels from day 1 (0.34 IU/ml). At steady state (day 3), mean peak anti-Xa levels of 0.13 IU/ml and 0.15 IU/ml were achieved with doses of 40 mg QD and 30 mg BID respectively. This increased significantly to 0.33 IU/ml and 0.40 IU/ml for doses of 40 mg BID and 1 mg/kg QD respectively. Thus anti-Xa response profiles differed significantly over the three days between enoxaparin treatment groups (P <0.0001). Doses of 40 mg BID and 1 mg/kg QD enoxaparin yielded target anti-Xa levels for over 80% of the study period. There were no adverse effects. CONCLUSIONS: Doses of 40 mg QD enoxaparin (Europe) or 30 mg BID (North America) yield levels of anti-Xa which may be inadequate for critically ill patients. A weight-based dose yielded the best anti-Xa levels without bioaccumulation, and allowed the establishment of near steady-state levels from the first day of enoxaparin administration. TRIAL REGISTRATION: Current Controlled Trials ISRCTN91570009.

Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia.

OBJECTIVES: Nutritional support during the neonatal and postoperative period in congenital diaphragmatic hernia (CDH) is challenging and controversial. We aimed to report on early enteral nutritional support in symptomatic CDH patients during the pre- and postoperative period, including feasibility, associated factors with established full enteral nutrition, and weight at birth, discharge, and 18 months. METHODS: We retrospectively collected data on nutrition: type and volume of enteral nutrition and parental support. Enteral feeding was introduced preoperatively from day 1 after birth, increased step-wised (breastmilk preferred), and resumed after CDH repair on the first postoperative day. Baseline data were available from our CDH database. RESULTS: From 2011 to 2020, we identified 45 CDH infants. Twenty-two were girls (51.1%), 35 left sided (77.8%), and 40 underwent CDH repair (88.9%). Median (interquartile range) length of stay in the pediatric intensive care unit was 14.6 days (6.0-26.5), and 1-year mortality was 17.8%.Postoperatively, 120 and 160 mL/kg/d of enteral nutrition was achieved after a median of 6.5 (3.6-12.6) and 10.6 (7.6-21.7) days, respectively. In total, 31 (68.9%) needed supplemental parenteral nutrition in a median period of 8 days (5-18), and of those 11 had parenteral nutrition initiated before CDH repair. No complications to enteral feeding were reported. CONCLUSION: Early enteral nutrition in CDH infants is feasible and may have the potential to reduce the need for parental nutrition and reduce time to full enteral nutrition in the postoperative period.

[Preoperative risk assessment of patients with congenital heart disease in non-cardiac surgery].

Over the last decades, remarkable advances in survival in patients with congenital heart disease (CHD) have been reported. Currently, 90% of infants born with CHD can expect to reach adulthood. Moderate and severe CHD is associated with increased perioperative mortality. To ensure optimal management of CHD patients undergoing non-cardiac surgery, preoperative risk assessment is pivotal, along with a multidisciplinary approach and collaboration across hospitals. The objective of this review is to provide a simple model to identify CHD patients at risk prior to non-cardiac surgery.

Suffering infertility: the impact of infertility on women's life experiences in two Nigerian communities.

This paper examines the experiences of women with infertility in two Nigerian communities with different systems of descent and historically different levels of infertility. First, the paper focuses on the life experiences of individual women across the two communities and second, it compares these experiences with those of their fertile counterparts, in each community. In doing this, women who are childless are distinguished from those with subfertility and compared with high-fertility women. The research is based on interdisciplinary research conducted among the Ijo and Yakurr people of southern Nigeria, which included a survey of approximately 100 childless and subfertile women and a matching sample of 100 fertile women as well as in-depth ethnographic interviews with childless and subfertile women in two communities: Amakiri in Delta State and Lopon in Cross River State. The findings indicate that while there are variations in the extent to which childlessness is considered to be problematic, the necessity for a woman to have a child remains basic in this region.

The impact of childhood sexual abuse and intimate partner violence on sexually transmitted infections.

Childhood sexual abuse (CSA) and adult intimate partner violence (IPV) have both been found to be associated with sexually transmitted infections (STIs) independently, but studies of STIs have rarely looked at victimization during both childhood and adulthood. This paper examines the relationship between CSA, IPV and STIs using data from a nested case-control study of 309 women recruited from multiple health care settings. Overall, 37.3% of women experienced no violence, 10.3% experienced CSA only, 27.3% experienced IPV only, and 25.0% experienced both CSA and IPV. Having ever been diagnosed with an STI was associated with violence (CSA only, odds ratios [OR] = 2.8, 95% confidence intervals [CI] = 1.0-7.5; IPV only, OR = 2.2, 95% CI = 1.0-4.9; CSA and IPV: OR = 4.0, 95% CI = 1.7-9.4), controlling for demographic characteristics. Women who experienced CSA were younger when they were first diagnosed. Understanding how both childhood and adult victimization are associated with diagnosis of STIs is important to reducing the incidence and prevalence of STIs, as well as the associated consequences of STIs.

Alcohol abuse, sexual risk behaviors, and sexually transmitted infections in women in Moshi urban district, northern Tanzania.

BACKGROUND: To assess the covariates of alcohol abuse and the association between alcohol abuse, high-risk sexual behaviors and sexually transmitted infections (STIs). METHODS: Two thousand and nineteen women aged 20 to 44 were randomly selected in a 2-stage sampling from the Moshi urban district of northern Tanzania. Participant's demographic and socio-economic characteristics, alcohol use, sexual behaviors, and STIs were assessed. Blood and urine samples were drawn for testing of human immunodeficiency virus, herpes simplex virus, syphilis, chlamydia, gonorrhea, trichomonas, and mycoplasma genitalium infections. RESULTS: Adjusted analyses showed that a history of physical (OR = 2.05; 95% CI: 1.06-3.98) and sexual violence (OR = 1.63; 95% CI: 1.05-2.51) was associated with alcohol abuse. Moreover, alcohol abuse was associated with number of sexual partners (OR = 1.66; 95% CI: 1.01-2.73). Women who abused alcohol were more likely to report STIs symptoms (OR = 1.61; 95% CI: 1.08-2.40). Women who had multiple sexual partners were more likely to have an STI (OR = 2.41; 95% CI: 1.46-4.00) compared to women with 1 sexual partner. There was no direct association between alcohol abuse and prevalence of STIs (OR = 0.86; 95% CI: 0.55-1.34). However, alcohol abuse was indirectly associated with STIs through its association with multiple sexual partners. CONCLUSIONS: The findings of alcohol abuse among physically and sexually violated women as well as the association between alcohol abuse and a history of symptoms of STIs and testing positive for STIs have significant public health implications. In sub-Saharan Africa, where women are disproportionately affected by the HIV epidemic screening for alcohol use should be part of comprehensive STIs and HIV prevention programs.

Association of age at first sex with HIV-1, HSV-2, and other sexual transmitted infections among women in northern Tanzania.

BACKGROUND: To examine the association between age at first sex and the prevalence of sexually transmitted infections (STIs), including HIV-1 and HSV-2, in women in Moshi urban district, northern Tanzania. METHODS: A total of 2019 women aged 20 to 44 were randomly selected in a 2-stage sampling from Moshi urban district, northern Tanzania. Information on demographics and sexual behaviors were obtained. Blood and urine samples were drawn for testing of HIV-1, HSV-2, and other STIs. RESULTS: Women who had their first sexual intercourse at age between 18 and 19 (OR = 0.66; 95% CI = 0.50-0.86) or 20+ (OR = 0.46; 95% CI = 0.36-0.60) were less likely to have STIs, including HIV-1 and HSV-2, than women who had their first intercourse before their 18th birthday. The hazards of having had first sex at an earlier age were significantly higher for women who tested positive for STIs (HR = 1.52; 95% CI: 1.37-1.69) or had STI symptoms (HR = 1.17; 95% CI: 1.05-1.30). Early age at first sex was associated with having a regular noncohabiting partner (HR = 1.40; 95% CI: 1.23-1.58), female circumcision (HR = 1.20; 95% CI: 1.02-1.40), and coercion at first intercourse (HR = 1.47; 95% CI: 1.15-1.89). CONCLUSIONS: In sub-Saharan Africa, where the prevalence of HIV and other STIs is high, a better understanding of the determinants of the age at first sex is crucial for HIV/STI prevention programs. Prevention programs should not only aim at delaying the age at first sex but also address factors leading to early age at first sex.

Coaggregation between probiotic bacteria and caries-associated strains: an in vitro study.

OBJECTIVE: To evaluate the in vitro abilities of probiotic bacteria derived from consumer products to coaggregate with caries-associated mutans streptococci. MATERIAL AND METHODS: Six lactobacillus strains (L. acidophilus (CCUG 5917), L. plantarum 299v, L. rhamnosus GG and LB21, L. paracasei F19, L. reuteri PTA5289) were cultivated under anaerobic conditions at 37°C in Man Rogosa Sharpe (MSB) broth for 24 h. Four strains of human streptococci (S. mutans Ingbritt, S. mutans (ATCC 25175), S. mutans GS-5, S. sobrinus (ATCC 33478) were similarly grown in Brain Heart Infusion (BHI) broth. A gastrointestinal pathogen (Escherichia coli) was aerobically cultivated on BHI broth as a positive control. After incubation, the bacteria were aerobically harvested, washed, and suspended in 10 mmol/l phosphate-buffered saline (pH 7.2). The probiotic strains were characterized with the API 50 CH system to confirm their identity. Coaggregation was determined by spectrophotometry in mixtures and bacterial suspensions alone after 1, 2, 4, and 24 h and expressed as the aggregation ratio (%). RESULTS: All probiotic strains showed coaggregation abilities with the oral pathogens and the results were strain specific and dependent on time. S. mutans GS-5 exhibited a significantly higher ability to coaggregate with all the probiotic strains than the other mutans streptococci and E. coli. The differences among the probiotic strains were modest with L. acidophilus being the most prone and L. rhamnosus LB21 the least prone to coaggregate with the oral streptococci. CONCLUSIONS: The results demonstrated different abilities of lactobacilli-derived probiotic bacteria to coaggregate with selected oral streptococci. Aggregation assays may be a useful complement for screening of probiotic candidates with possible anti-caries properties.

Prevalence of and risk factors associated with alcohol abuse in Moshi, northern Tanzania.

This study aimed to assess the prevalence of and risk factors associated with alcohol abuse among women and men in Moshi in northern Tanzania. Alcohol abuse was measured by a CAGE score of 2-4, versus 0-1 for no alcohol abuse (Ewing, 1984). Crude and adjusted logistic regression models determined odds ratios (OR) and 95% confidence intervals (95% CI) of alcohol abuse by characteristics of, respectively, women with partners (n=1200), women without partners (n=614) and men (n=788) (women's partners). Prevalence of alcohol abuse was 7.0% (95% CI: 5.6-8.4) among women with partners, 9.3% (95% CI: 7.0-11.6) among women without partners, and more than double among men at 22.8% (95% CI: 19.9-25.8). In general, Christians had higher alcohol abuse than Muslims or other religions, as did Chagga men compared with men of other ethnic groups. Other socio-demographic characteristics, such as education or income, were not significant. Sexual behaviours were significant predictors of alcohol abuse. For example, women without partners who reported more than two partners in the last year had higher alcohol abuse compared with women reporting no partners (OR=8.75; 95% CI: 2.37-32.31), as did men reporting it is 'OK to hit a partner' for any reason (OR=1.79; 95% CI: 1.16-2.77) compared with men who did not. HIV-1 infection was not significantly associated with alcohol abuse by women or men. The Christian Church in Moshi should consider raising awareness about the harmful effects of high alcohol use among its adherents. Comprehensive programmes focusing on reducing number of partners and alcohol use, particularly by men, are needed in this community.

Gender inequality increases women's risk of hiv infection in Moshi, Tanzania.

This study examined the hypothesis that multiple dimensions of gender inequality increase women's risk for HIV infection using a population-based survey of 1418 women aged 20 to 44 in Moshi, Tanzania. Three forms of HIV exposures were assessed reflecting gender power imbalance: economic exposures (age difference between partners and partner's contributions to children's expenses), physical exposures (coerced first sex and intimate partner violence) and social exposures (ever had problems conceiving). Behavioural risk factors included number of sexual partners for women in the last three years, partner had other wives or girlfriends, non-use of condom and alcohol use at least once a week in the last 12 months. Multivariate logistic regression analysis showed that a woman had a significantly elevated risk for HIV if she had a partner more than 10 years older (OR=2.5), her partner made low financial contributions to children's expenses (OR=1.7), or she experienced coerced first sex before age 18 years (OR=2.0) even after taking into account the effects of risk behaviour factors. The association between ever had problem conceiving and HIV infection was explained away by risk behaviour factors. The findings lend support to the hypothesis that economic deprivation and experience of sexual violence increase women's vulnerability to HIV, providing further evidence for extending the behavioural approach to HIV interventions to incorporate women's economic empowerment, elimination of gender-based violence and promotion of changing attitudes and behaviours among men.

Sexual violence at first intercourse against women in Moshi, northern Tanzania: prevalence, risk factors, and consequences.

To explore the relationship between sexual violence at first intercourse and later sexually transmitted infections (STIs) in Moshi, Tanzania, we analysed data from a representative household survey that comprised face-to-face interviews with 1,835 women and tests for six STIs on biological samples from 1,235 of these women. Overall, 10.9 per cent report forced first intercourse and 15.3 per cent report unwanted first intercourse. Unadjusted analysis shows a relationship between forced first intercourse and STIs (OR: 1.72, 95 per cent CI: 1.19-2.51). Life-course variables mediate this relationship. Significant predictors of having an STI include older age, more sexual partners, and a partner who has children with other women. Coerced first intercourse appears to be associated with changes in the life course of women and with a heightened risk of contracting an STI.

Intimate partner violence and women's contraceptive use.

Intimate partner violence has been hypothesized as a factor associated with women's risk for problems in contraception use or access. This article explores differences in contraceptive use between abused and nonabused women, using a case-control study of 225 women. Women experiencing physical and emotional abuse were more likely to report not using their preferred method of contraception in the past 12 months compared with nonabused women (OR = 1.9; 95% CI = 1.0 to 3.7). Health care providers need to consider how intimate partner violence may influence their patients' use of contraceptives, which has implications for the high risk of unintended pregnancies among abused women.

HIV-1 infection and fertility in Dar es Salaam, Tanzania.

The objective of this study was to examine the association of HIV-1 infection with rates of pregnancy and pregnancy loss in Dar es Salaam, Tanzania. A retrospective cohort study of 1,006 HIV-infected women and 485 uninfected women was employed. In multivariate analyses controlling for other predictors of pregnancy, the association of HIV-seropositivity with a woman's reported number of pregnancies was of borderline significance (RR = 1.13, 95% CI = 1.00, 1.27). HIV infection was not associated with pregnancy loss in multivariate analysis. The adjusted pregnancy rate ratio comparing HIV-positive women at the earliest stages of infection to all uninfected women was 1.22 (95% CI = 1.04, 1.42). HIV infection was not associated with female fertility when comparing women in the most advanced stages of infection to all uninfected women. We conclude that HIV-1 infected women had higher pregnancy rates than uninfected women. This association disappeared when analyses were limited to women with advanced disease. Abstract word count: 150.

Risk factors for complications of induced abortions in Nigeria.

BACKGROUND: The prevalence and risk factors for unsafe abortions and their complications are not well defined. METHODS: A cross-sectional study of patient-reported reproductive history was conducted in three hospitals in southwest Nigeria from 1998 to 1999. Data on pregnancy outcomes and sociodemographic characteristics were collected for 1836 women ages 15-49 seeking family planning and antenatal services. Independent predictors for complications from induced abortion of first pregnancies were analyzed using logistic regression models. RESULTS: Four hundred twenty-four women (29.7%) terminated their first pregnancy. As many as 43.1% of women unmarried at first pregnancy had an abortion, and being unmarried at pregnancy was the strongest predictor of abortion in the adjusted model. Almost 30% experienced complications at the time of abortion (heavy bleeding, high fever, and other), and 22.9% reported complications subsequent to and within 6 weeks of abortion. Heavy bleeding and 6-week complications were significantly associated with age at pregnancy, circumcision, and religion, and 87.6% of women with 6-week complications reported complications for 1 day. Type of provider was the sole significant predictor of fever, and doctor provider reduced the risk of fever. Induced abortion and related complications were common despite the widespread provision by doctors. CONCLUSIONS: Policies and programs should address improving abortion practices and postabortion care, increasing contraceptive use, and reducing the practice of female circumcision.

Gender inequality and intimate partner violence among women in Moshi, Tanzania.

CONTEXT: In Sub-Saharan Africa, where rates of intimate partner violence are high, knowing the prevalence of abuse and associated patterns of risk is crucial to ensuring women's health and development. Intimate partner violence in Tanzania has not been assessed through a population-based survey. METHODS: A household-based sample of women aged 20-44 in the urban district of Moshi, Tanzania, participated in face-to-face interviews in 2002-2003. The lifetime prevalence of exposure to intimate partner violence and the prevalence of exposure during the past 12 months were assessed among 1,444 women who reported having a current partner. Multivariate logistic regression was used to identify factors associated with intimate partner violence. RESULTS: Twenty-one percent of women reported having experienced intimate partner violence (i.e., having been threatened with physical abuse, subjected to physical abuse or forced into intercourse by a partner) during the previous 12 months; 26% reported such an experience at any time, including the past 12 months. The likelihood of violence in the past year was elevated if the woman had had problems conceiving or had borne five or more children (odds ratios, 1.9 and 2.4, respectively); if her husband or partner had other partners (2.0) or contributed little to expenses for her and her children (3.3); and if she had had no more than a primary education (1.7). CONCLUSIONS: Gender inequality within sexual unions is associated with intimate partner violence. Policies and programs that discourage men from blaming women for infertility, promote monogamous unions and expand access to education for women may reduce intimate partner violence in northern urban Tanzania.

Breastfeeding and maternal HIV-1 disease progression and mortality.

OBJECTIVE: To examine the association between breastfeeding and disease progression among HIV-infected women in Dar es Salaam, Tanzania. DESIGN AND METHODS: Cohort study design with Cox proportional hazards models. RESULTS: The relative risk of death comparing women who recently had been breastfeeding to those who were not breastfeeding was 0.47 (95% confidence interval, 0.18-1.20). Neither breastfeeding status nor the duration of exclusive or partial breastfeeding was associated with HIV-1 disease progression, represented by death or development of a low CD4 cell count, anemia or excessive weight loss, in multivariate analyses. These associations remained insignificant when women with relatively low and high CD4 cell counts were analyzed separately. CONCLUSION: There is insufficient evidence to support the hypothesis that breastfeeding is detrimental to the health of HIV-infected women.

Women's empowerment and fertility decline among the Pare of Kilimanjaro region, Northern Tanzania.

This research was designed to explore the connection between the empowerment of women and fertility outcomes, through an ethnographic study, a community-based survey and in-depth interviews. The purpose of the work is to test the relationship between a fertility decline and the status of women in a rural area of Kilimanjaro Region, Tanzania. Our major hypothesis was that the decline in fertility in the Kilimanjaro Region-given that the preconditions proposed by Caldwell, Orubuloye, and Caldwell (1992) have been satisfied-is due to the empowerment of women, particularly to gender equity within families. Research was conducted in two villages-Masumbeni and Kisanjuni-located in the Ugweno Division of the Pare Mountains in the eastern part of Kilimanjaro Region. Findings show that in this population age at first birth increased and the progression from having one child to the next child declined. This pattern was evident during the 1980s, it is stronger in the 1990s. The factors associated with this phenomenon are those related to the status of women, particularly, free partner choice, women's education and wealth of the family.

Which African men promote smaller families and why? Marital relations and fertility in a Pare community in Northern Tanzania.

This research comes in the wake of increasing interest in men's roles in childbearing decisions in sub-Saharan Africa. While some of the findings indicate that men tend to hinder fertility decline, we aimed to identify which men desire fewer children, under what circumstances, and why. The research was done in a Pare community in Northern Tanzania. It is our hypothesis that differences in men's fertility desires and decisions are to be sought in the context of their conjugal union. This paper, based on data from a case study from two Pare villages, attempts to examine the relationship between male attitudes toward reproduction and marital relations. The methodology consisted of a combination of an ethnographic study and in-depth interviews. A subsequent survey, the questions for which were derived from the qualitative work, was administered in order to verify the generalisability of the findings of the qualitative work. Findings show that those men who desire fewer children are younger, educated at least to the primary and often to the secondary level, their wives have also completed at least primary school, they are more affluent, and they are likely to be Christian. They are in a marital relationship where the partners chose each other, they communicate with their wives about important issues, and make joint decisions, including the number of children they should have. The discussion relates the differences in the marital patterns and fertility preferences to differences in the life plans of Christians and Muslims in this community.