Attitudes towards female genital cutting among adolescents in rural Burkina Faso: A multilevel analysis Female genital cutting in Burkina Faso

Objective: Despite decades of abandonment efforts, female genital cutting (FGC) prevalence rates in Burkina Faso remain high. We present updated prevalence data from rural adolescents and examine factors associated with FGC receipt and attitudes, testing predictions of social convention and modernisation theory regarding the abandonment process. Methods: We interviewed 1644 adolescents aged 12–20 years from 10 villages and one sector of Nouna town in the Nouna Health and Demographic Surveillance site in late 2017. Response‐weighted prevalence for self‐reported FGC receipt, beliefs about religious requirements, and attitudes about abandonment were calculated. We used bivariate regression and two‐level hierarchical models to test whether social convention or modernisation theory‐related factors predicted current FGC attitudes. Results: 43% of women in our sample reported having undergone FGC; 74% of women and 76% of men believed FGC should be abandoned. The strongest predictors of FGC receipt were religion, ethnicity, the village’s FGC rate and mother’s education. The strongest predictors of FGC abandonment attitudes were religion, ethnicity, belief that FGC is religiously required, and own FGC status. Males’ attitudes were less determined by community factors than females’; females’ attitudes were more strongly influenced by factors linked to modernization, such as maternal education and household wealth. Conclusions: FGC continues to be common in rural and small‐town Burkina Faso, and our analysis suggests that social conventions play an important role in its continuation. However, modernisation‐related factors were stronger predictors of abandonment attitudes than of FGC status, particularly in adolescent women. The changes these relationships suggest may benefit the next generation of girls

Challenges and achievements in the utilization of the health system among adolescents in a region of Burkina Faso particularly affected by poverty

Objective: Healthcare for adolescents receives little attention in low-income countries globally despite their large population share in these settings, the importance of disease prevention at these ages for later life outcomes and adolescent health needs differing from those of other ages. We therefore examined healthcare need and use among adolescents in rural Burkina Faso to identify reasons for use and gaps in provision and uptake. Methods: We interviewed 1,644 adolescents aged 12-20 living in rural northwestern Burkina Faso in 2017. Topics included healthcare need and satisfaction with care provided. We calculated response-weighted prevalence of perceived healthcare need and utilization, then conducted multivariable regression to look at predictors of need, realized access and successful utilization based on the Andersen and Aday model. Results: 43.7 [41.2 - 46.0] % of participants perceived need for healthcare at least once in the preceding 12 months - 52.0 [48.1 - 56.0] % of females and 35.6 [32.5 - 39.0] % of males. Of those with perceived need, 92.6 [90.0 - 94.3] % were able to access care and 79.0 [75.6 - 82.0] % obtained successful utilization. Need was most strongly predicted by gender, education and urbanicity, while predictors of successful use included household wealth and female guardian’s educational attainment. Conclusion: Healthcare utilization among adolescents is low in rural Burkina Faso, but mostly thought of as sufficient with very few individuals reporting need that was not linked to care. Future objective assessment of healthcare need could help identify whether our results reflect a well-functioning system for these adolescents, or one where barriers lead to low awareness of needs or low expectations for service provision

Sequestered Dark Matter

We show that hidden-sector dark matter is a generic feature of the type IIB string theory landscape and that its lifetime may allow for a discovery through the observation of very energetic gamma-rays produced in the decay. Throats or, equivalently, conformally sequestered hidden sectors are common in flux compactifications and the energy deposited in these sectors can be calculated if the reheating temperature of the standard model sector is known. Assuming that throats with various warp factors are available in the compact manifold, we determine which throats maximize the late-time abundance of sequestered dark matter. For such throats, this abundance agrees with cosmological data if the standard model reheating temperature was 10^10 - 10^11 GeV. In two distinct scenarios, the mass of dark matter particles, i.e. the IR scale of the throat, is either around 10^5 GeV or around 10^10 GeV. The lifetime and the decay channels of our dark matter candidates depend crucially on the fact that the Klebanov-Strassler throat is supersymmetric. Furthermore, the details of supersymmetry breaking both in the throat and in the visible sector play an essential role. We identify a number of scenarios where this type of dark matter can be discovered via gamma-ray observations.Comment: 36 pages, 3 figures; v2: references added, v3: introduction extended and typos correcte

‘If he sees it with his own eyes, he will understand’: how gender informed the content and delivery of a maternal nutrition intervention in Burkina Faso

A growing body of literature urges policymakers, practitioners and scientists to consider gender in the design and evaluation of health interventions. We report findings from formative research to develop and refine an mHealth maternal nutrition intervention in Nouna, Burkina Faso, one of the world's most resource-poor settings. Gender was not an initial research focus, but emerged as highly salient during data collection, and thus guided lines of inquiry as the study progressed. We collected data in two stages, first using focus group discussions (FGD; n = 8) and later using FGDs (n = 2), interviews (n = 30) and observations of intervention delivery (n = 30). Respondents included pregnant women, breastfeeding mothers and Close-to-Community (CTC) providers, who execute preventative and curative tasks at the community level. We applied Morgan et al.'s gender framework to examine intervention content (what a gender-sensitive nutrition programme should entail) and delivery (how a gender-sensitive programme should be administered). Mothers emphasized that although they are often the focus of nutrition interventions, they are not empowered to make nutrition-based decisions that incur costs. They do, however, wield some control over nutrition-related tasks such as farming and cooking. Mothers described how difficult it is to consider only one's own children during meal preparation (which is communal), and all respondents described how nutrition-related requests can spark marital strife. Many respondents agreed that involving men in nutrition interventions is vital, despite men's perceived disinterest. CTC providers and others described how social norms and gender roles underpin perceptions of CTC providers and dictate with whom they can speak within homes. Mothers often prefer female CTC providers, but these health workers require spousal permission to work and need to balance professional and domestic demands. We recommend involving male partners in maternal nutrition interventions and engaging and supporting a broader cadre of female CTC providers in Burkina Faso

Iterative Adaptation of a Mobile Health Intervention Across Countries Using Human-Centered Design: Qualitative Study

Background: Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective: The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods: Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results: We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions: Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions

Effectiveness and resource requirements of test, trace and isolate strategies for COVID in the UK

We use an individual-level transmission and contact simulation model to explore the effectiveness and resource requirements of various test-trace-isolate (TTI) strategies for reducing the spread of SARS-CoV-2 in the UK, in the context of different scenarios with varying levels of stringency of non-pharmaceutical interventions. Based on modelling results, we show that selfisolation of symptomatic individuals and quarantine of their household contacts has a substantial impact on the number of new infections generated by each primary case. We further show that adding contact tracing of non-household contacts of confirmed cases to this broader package of interventions reduces the number of new infections otherwise generated by 5–15%. We also explore impact of key factors, such as tracing application adoption and testing delay, on overall effectiveness of TTI

Frailty and physical performance in the context of extreme poverty: a population-based study of older adults in rural Burkina Faso [version 1; peer review: 2 approved]

Background: Little is known about the prevalence of frailty and about normal values for physical performance among older individuals in low-income countries, in particular those in sub-Saharan Africa. We describe the prevalence of phenotypic frailty, and values and correlates of several physical performance measures in a cohort of middle-aged and older people living in rural Burkina Faso, one of the world’s poorest communities. Methods: We analysed data collected from participants aged over 40 in Nouna district, Burkina Faso. We measured handgrip strength, four metre walk speed, chair rise time, and derived the Fried frailty score based on grip strength, gait speed, body mass index, self-reported exhaustion, and physical activity. Frailty and physical performance indicators were then correlated with health and sociodemographic variables including comorbid disease, marital status, age, sex, wealth and activity impairment. Results: Our sample included 2973 individuals (1503 women), mean age 54 years. 1207 (43%) were categorised as non-frail, 1324 (44%) as prefrail, 212 (7%) as frail, and 167 (6%) were unable to complete all five frailty score components. Lower grip strength, longer chair stand time, lower walk speed and prevalence of frailty rose with age. Frailty was more common in women than men (8% vs 6%, p=0.01) except in those aged 80 and over. Frailty was strongly associated with impairment of activities of daily living and with lower wealth, being widowed, diabetes mellitus, hypertension, and self-reported diagnoses of tuberculosis or heart disease. With the exception of grip strength, which was higher in women than prior international normative values, women had greater deficits than men in physical performance. Conclusions: Phenotypic frailty and impaired physical performance were associated as expected with female sex, co-morbidities, increasing age and impaired activities of daily living. These results support the use of frailty measurements for classification of ageing related syndromes in this setting

Energy Transfer between Throats from a 10d Perspective

Strongly warped regions, also known as throats, are a common feature of the type IIB string theory landscape. If one of the throats is heated during cosmological evolution, the energy is subsequently transferred to other throats or to massless fields in the unwarped bulk of the Calabi-Yau orientifold. This energy transfer proceeds either by Hawking radiation from the black hole horizon in the heated throat or, at later times, by the decay of throat-localized Kaluza-Klein states. In both cases, we calculate in a 10d setup the energy transfer rate (respectively decay rate) as a function of the AdS scales of the throats and of their relative distance. Compared to existing results based on 5d models, we find a significant suppression of the energy transfer rates if the size of the embedding Calabi-Yau orientifold is much larger than the AdS radii of the throats. This effect can be partially compensated by a small distance between the throats. These results are relevant, e.g., for the analysis of reheating after brane inflation. Our calculation employs the dual gauge theory picture in which each throat is described by a strongly coupled 4d gauge theory, the degrees of freedom of which are localized at a certain position in the compact space.Comment: 25 pages; a comment adde

Effect of HIV self-testing on the number of sexual partners among female sex workers in Zambia: A randomized controlled trial

Objectives: To assess the effect of two health system approaches to distribute HIV selftests on the number of female sex workers’ client and nonclient sexual partners. Design: Cluster randomized controlled trial. Methods: Peer educators recruited 965 participants. Peer educator–participant groups were randomized 1 : 1 : 1 to one of three arms: delivery of HIV self-tests directly from a peer educator, free facility-based delivery of HIV self-tests in exchange for coupons, or referral to standard-of-care HIV testing. Participants in all three arms completed four peer educator intervention sessions, which included counseling and condom distribution. Participants were asked the average number of client partners they had per night at baseline, 1 and 4 months, and the number of nonclient partners they had in the past 12 months (at baseline) and in the past month (at 1 month and 4 months). Results: At 4 months, participants reported significantly fewer clients per night in the direct delivery arm (mean difference 0.78 clients, 95% CI 1.28 to 0.28, P ¼ 0.002) and the coupon arm (0.71, 95% CI 1.21 to 0.21, P ¼ 0.005) compared with standard of care. Similarly, they reported fewer nonclient partners in the direct delivery arm (3.19, 95% CI 5.18 to 1.21, P ¼ 0.002) and in the coupon arm (1.84, 95% CI 3.81 to 0.14, P ¼ 0.07) arm compared with standard of care. Conclusion: Expansion of HIV self-testing may have positive behavioral effects enhancing other HIV prevention efforts among female sex workers in Zambia. Trial Registration: ClinicalTrials.gov NCT02827240. Copyrigh

Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide study

We investigated stage at diagnosis in relation to socioeconomic status (SES) among 15 274 patients with colorectal adenocarcinoma diagnosed in 1996–2004 nationwide in Denmark. The effect of SES on the risk of being diagnosed with distant metastasis was analysed using logistic regression models. A reduction in the risk of being diagnosed with distant metastasis was seen in elderly rectal cancer patients with high income, living in owner–occupied housing and living with a partner. Among younger rectal cancer patients, a reduced risk was seen in those having long education. No social gradient was found among colon cancer patients. The social gradient found in rectal cancer patients was significantly different from the lack of association found among colon cancer patients. There are socioeconomic inequalities in the risk of being diagnosed with distant metastasis of a rectal, but not a colonic, cancer. The different risk profile of these two cancers may reflect differences in symptomatology