Correspondence
male-to-female sex ratio of children
born in India:national survey of 1·1 million
households. Lancet 2006; 367: 211–18.
2 Sheth SS. Missing female births in India.
Lancet 2006; 367: 185–86.
3 Martineau A, White M, Bhopal R. No sex
differences in immunisation rates of British
south Asian children: the effect of migration?
BMJ 1997; 314: 642–43.
Shirish Sheth (Jan 21, p 185)1 rightly
decries the appalling fact that, as a
result of abortion, “about 100 million
girls are missing from the world—they
are dead”, and properly emphasises
that, since 1986, all members of
the Federation of Obstetric and
Gynaecological Societies of India have
been “asked to desist, dissociate, and
discourage female feticide as it is a
‘crime against humanity’”. My questions
are these: are all abortions—or even
just abortions on demand for non-
medical reasons—feticide or does that
term only apply to female fetuses? If
the latter, what is the justification for
the distinction?
I declare that I have no conflict of interest.
Margaret Somerville
margaret.somerville@mcgill.ca
Centre for Medicine, Ethics and Law, McGill
University, Montreal, Quebec H3A 1W9, Canada
1 Sheth SS. Missing female births in India. Lancet
2006; 367: 185–86.
Aid for Africa: listen to
women leaders
Your Editorial entitled “A global
famine” (Mar 18, p 876)1 highlights the
fact that malnutrition remains a major
public health issue in Africa. To cope
with this crisis, the Prime Ministers
of Senegal and Madagascar have
eloquently taken the lead.2 However,
where such governmental leadership
is not fully expressed, we must rely on
local leaders who work closely with
their target population.
To assist African community leaders,
the Obihiro International Center of
the Japan International Cooperation
Agency has run a 2·5-month training
course on nutrition and dietary
www.thelancet.com Vol 367 May 27, 2006
improvement for women leaders for
the past 5 years. The participants,
about ten each year, have all been
aged 30–60 years and work in various
government sectors in sub-Saharan
African countries.
We have been involved with this
training course for the past 3 years.
Although we worked as instructors,
we have learned a great deal from
the participants. Most were not
satisfied with solutions that would
simply deliver food or micronutrient
supplements. A Senegalese participant
claimed that there is sufficient food
in Senegal, but that the issue is how
to improve the eating behaviour of
mothers and children. A South African
participant stated that she did not
expect money, but an experienced
adviser who could assist her in her
development efforts.
One participant from Kenya said that
she did her best to improve the health
and nutrition of AIDS orphans in her
target community without external
support; however, she was obliged
to give up her initiative, not because
she lacked millions of US dollars but
just a few hundred. As described in
the World Report of the same issue,3
humanitarian assistance, such as
tonnes of food aid or millions of US
dollars, might be critical for emergency
relief, but we should be aware that
some locally initiated activities have
gone down the drain because of a lack
of minimum support.
We declare that we have no conflict of interest.
*Masamine Jimba, Kayako Sakisaka,
Kyo Hanada
mjimba@m.u-tokyo.ac.jp
Departments of *International Community
Health (MJ) and Health Policy and Planning (KS),
Graduate School of Medicine, University of
Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo,
113-0033 Japan; and Institute for International
Cooperation, Japan International Cooperation
Agency, Japan (KH)
1 The Lancet. A global famine. Lancet 2006;
367: 876.
2 Sall M, Sylla J. African Prime Ministers take lead
in child survival. Lancet 2005;
366: 1988–89.
3 Wakabi W. “Worst drought in a decade”
leaves Kenya crippled. Lancet 2006;
367: 891–92.
Gene-gene interactions
in myocardial infarction
Zheng Ye and colleagues (Feb 25,
p 651)1 report a moderate but
significant effect of factor V Leiden and
prothrombin 20210A polymorphisms
on coronary disease risk.
In their case-control meta-analysis,
Ye and colleagues did not include
reports focusing on gene-gene or
gene-environment interactions. In a
Newfoundland and Labrador pop-
ulation,2 the prothrombin 20210A
polymorphism conferred a 3·2-fold
increased risk of myocardial infarction,
but combined carriage of this poly-
morphism and the factor XIII 34Leu
allele had a synergistic effect, giving
a 12-fold increased risk of myocardial
infarction. Moreover, there was
disequilibrium of the factor XIII
34Leu allele among patients with a
genetic history of the prothrombin
polymorphism.
These results were reinforced
by similar data from a Spanish
population.3 In that study, the
prothrombin polymorphism alone
slightly increased the risk of myocardial
infarction (odds ratio 2·73, 95% CI
1·12–6·7), whereas coinheritance of
prothrombin 20210A and factor XIII
34Leu increased the risk to a level very
close to that of the Newfoundland and
Labrador study (12·12, 1·33–112·4).
Genetic epidemiology is a complex
science, especially in multifactorial Rights were not
diseases such as cardiovascular disease. granted to include
Genetic predisposition for myocardial this image in
infarction can result from an additive
electronic media.
or synergistic effect of several genes Please refer to the
which have only a small role by printed journal.
themselves. Therefore, as suggested
Still Pictures
by Ye and colleagues, large studies
focusing on gene-gene and gene-
environment interactions are needed
for a better understanding of such
diseases.
We declare that we have no conflict of interest.
*Gilles Pernod, Olivier Ormezzano,
Gérald Vanzetto
GPernod@chu-grenoble.fr
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