Assessing the Effect of Four Types of Direct Mail Messages to Promote the Uptake of Residential Lead Remediation Funds

Objective To examine the efficacy of direct mailing using four types of messaging on promoting the uptake of residential lead remediation (RLR) funds in Lancaster, PA, USA. Study design We designed a quasi-experiment to assess the effect of 4 RLR messages sent to households in Lancaster, PA by direct mail between September and December 2020: a brief flyer (F); a detailed brochure + the flyer (BF); a health infographic + the flyer (IF); and an application form + the flyer (AFF). Methods Mailers were sent to addresses in four census tracts; each census tract received a different message. Both English and Spanish versions were sent. The outcomes were the event rate defined as the number of phone call inquiries received, and the number of applications received. The association between type of messaging and household type (owner-vs renter-occupied) was assessed using a chi square test. Results The event rates for the renter-occupied households were lower than for owner-occupied households, regardless of treatment. The event rates for renter-occupied households in the F, BF, IF and AFF groups were 0.00%, 0.35%, 0.12% and 0.18% respectively compared to 0.93%, 0.45%, 0.86% and 1.32% for homeowners. More applications were received from homeowners, and the event rate of the owner-occupied households was significantly different from that of renter-occupied homes (p-value = 0.001). Conclusions Event rates and applications received were higher for owner-occupied households than they were for renter-occupied households. Direct mailing of RLR information is feasible especially if households at high risk for lead poisoning are targeted

Adolescent experiences of HIV and sexual health communication with parents and caregivers in Soweto, South Africa

Communication about sexual health between parents and adolescents has been shown to have a protective influence on behaviours that reduce the risk of HIV transmission. This study explored experiences of HIV and sexual health (HSH) communication between parents and/or caregivers and adolescents in an urban HIV-endemic community in Southern Africa. Adolescents (aged 14–19 years) were recruited from the Kganya Motsha Adolescent Centre and the Kliptown community between June and August 2009. Qualitative data were collected through focus group discussions (n = 10 adolescents) and semi-structured interviews (n = 31 adolescents). In total, 41 adolescents (56% female, 44% male, mean age = 17.2) participated in the study. Adolescent participants identified emotional, physical and sociocultural barriers to initiating HSH communication with parents and caregivers including fear of verbal warnings, threats and physical assault. Adolescents also expressed a desire for mentorship around HSH communication beyond abstinence and peer-based information. Public health interventions need to support adolescents’ access to bi-directional HSH information from adult mentors that address the lived realities of adolescents beyond expectations of abstinence.Keywords: adolescent, parent–adolescent communication, qualitative, sexual health, HIV prevention, South Afric

What do South African adolescents want in a sexual health service Evidence from the South African Studies on HIV in Adolescents SASHA project

Background. Young people in sub-Saharan Africa (SSA) are disproportionately affected by HIV, sexually transmitted infections and unplanned pregnancies. The provision of accessible sexual and reproductive health services (SRHS) for young people in SSA is vital to reduce this burden.Objectives. To examine the needs of South African (SA) adolescents with regard to differentiated, accessible and adolescent-responsive SRHS.Methods. Data were drawn from a larger project examining the feasibility of conducting HIV vaccine trials in adolescents. Fifteen focus group discussions were conducted across five research sites in four SA provinces with 120 male and female adolescent human papillomavirus vaccine trial participants aged 12 - 19 years from low-income areas with a high incidence of HIV. Transcribed data were double-coded using framework analysis.Results. Three main themes emerged on how best to improve SRHS for adolescents in resource-limited settings: adolescent-friendly services, availability of developmentally appropriate and tailored information, and improved relationships between healthcare workers and clinic attendees. Participants wanted more flexible opening hours at SRHS to account for travel time to clinics from school and home. They suggested that services include contraception, counselling, educational materials, links to adoption services, emergency vehicles, pre- and postnatal care, and improved service quality from clinic staff.Conclusions. While dedicated adolescent SRHS might best meet the needs of young people in SA, the study suggests that failing this, existing SRHS should be more responsive to adolescent use. Innovations such as mobile outreach services, self-testing and flexible hours will help SRHS respond to adolescents’ needs.Â

What do South African adolescents want in a sexual health service? Evidence from the South African Studies on HIV in Adolescents (SASHA) project

Background. Young people in sub-Saharan Africa (SSA) are disproportionately affected by HIV, sexually transmitted infections and unplanned pregnancies. The provision of accessible sexual and reproductive health services (SRHS) for young people in SSA is vital to reduce this burden.Objectives. To examine the needs of South African (SA) adolescents with regard to differentiated, accessible and adolescent-responsive SRHS.Methods. Data were drawn from a larger project examining the feasibility of conducting HIV vaccine trials in adolescents. Fifteen focus group discussions were conducted across five research sites in four SA provinces with 120 male and female adolescent human papillomavirus vaccine trial participants aged 12 - 19 years from low-income areas with a high incidence of HIV. Transcribed data were double-coded using framework analysis.Results. Three main themes emerged on how best to improve SRHS for adolescents in resource-limited settings: adolescent-friendly services, availability of developmentally appropriate and tailored information, and improved relationships between healthcare workers and clinic attendees. Participants wanted more flexible opening hours at SRHS to account for travel time to clinics from school and home. They suggested that services include contraception, counselling, educational materials, links to adoption services, emergency vehicles, pre- and postnatal care, and improved service quality from clinic staff.Conclusions. While dedicated adolescent SRHS might best meet the needs of young people in SA, the study suggests that failing this, existing SRHS should be more responsive to adolescent use. Innovations such as mobile outreach services, self-testing and flexible hours will help SRHS respond to adolescents’ needs.

Facing the stranger in the mirror: Staged complicities in recent South African performances

The staging of complicity has developed into one of the most prevalent trends in recent South Africa theatre. The audience may become aware of their own complicity in injustice, or complicity may feature as a subject to be explored in the play. I will argue that one can identify three broadly defined performance modalities which shape current engagements with complicity. These modalities are identified by the adjectives, 'thick' (as in densely layered, complex, deep), 'reflective' (as in reflecting upon as well as revealing), and 'hard' (in the sense of direct, uncompromising, difficult to penetrate). Rather than signifying distinct categories, these terms are attributed to a cluster of performance dynamics.DHE

Prevalence and Predictors of Exclusive Breastfeeding among Women in Kilimanjaro Region, Northern Tanzania: A Population Based Cross-Sectional Study.

Exclusive breastfeeding (EBF) is a simple and cost-effective intervention to improve child health and survival. Effective EBF has been estimated to avert 13% - 15% of under-five mortality and contribute to reduce mother to child transmission of HIV. The prevalence of EBF for infant less than six months is low in most developing countries, including Tanzania (50%). While the Tanzania Demographic Health Survey collects information on overall EBF prevalence, it does not evaluate factors influencing EBF. The aim of this paper was to determine the prevalence and predictors of exclusive breastfeeding in urban and rural areas in Kilimanjaro region. A population-based cross-sectional study was conducted between June 2010 to March 2011 among women with infants aged 6-12 months in Kilimanjaro. Multi-stage proportionate to size sampling was used to select participants from all the seven districts of the region. A standardized questionnaire was used to collect socio-demographic, reproductive, alcohol intake, breastfeeding patterns and nutritional data during the interviews. Estimation on EBF was based on recall since birth. Multivariable logistic regression was used to obtain independent predictors of EBF. A total of 624 women participated, 77% (483) from rural areas. The prevalence of EBF up to six months in Kilimanjaro region was 20.7%, without significant differences in the prevalence of EBF up to six months between urban (22.7%) and rural areas (20.1%); (OR = 0.7, 95% CI 0.5,1.4).In multivariable analysis, advice on breastfeeding after delivery (Adjusted odds ratio, AOR = 2.6, 95% CI 1.5, 4.6) was positively associated with EBF up to six months. Compared to married/cohabiting and those who do not take alcohol, single mothers (AOR = 0.4, 95% CI 0.2, 0.9) and mothers who drank alcohol (AOR = 0.4, 95% CI 0.3, 0.7) had less odds to practice EBF up to six months. Prevalence of EBF up to six months is still low in Kilimanjaro, lower than the national coverage of 50%. Strengthening of EBF counseling in all reproductive and child health clinics especially during antenatal and postnatal periods may help to improve EBF rates

Assessment of Service Availability and Health Care Workers’ Opinions about Young Women’s Sexual and Reproductive Health in Soweto, South Africa

Young women in South Africa experience high HIV and unintended pregnancy rates. Health care workers’ (HCWs’) opinions about sexual and reproductive health (SRH) issues impact young women’s ability to access SRH services. We explored HCW opinions through interviews with a purposive sample of 29 HCWs in three primary health clinics in Soweto, South Africa and examined service availability through facility assessments. Most HCWs believed young women should not have sex before marriage and thought that young women ignore information they receive about HIV and pregnancy prevention. HCWs acknowledged outside factors influencing young women’s ability to protect themselves. Most thought injectables were the most appropriate contraception for young women; all recognized the importance of condoms for dual protection. Some services were only reported to be provided to those over 18 years. HCWs may benefit from workshops providing technical and policy information and values clarification exercises highlighting the impact of opinions on service provision.Les jeunes femmes en Afrique du Sud connaissent de taux élevés du VIH et de grossesse non voulues. Les opinions des membres du personnel soignant (MPS) sur les problèmes de la santé sexuelle et de reproduction (SSR) influencent la capacité des jeunes femmes d’avoir accès aux services de la SSR. Nous avons exploré les opinions des MPS à travers les interviews en profondeur avec un échantillon calculé de 29 MPS dans trois cliniques de santé primaire à Soweto, Afrique du Sud et nous avons examiné la disponibilité des services à travers les évaluations des établissements. La plupart des MPS ont cru que les jeunes ne devraient pas avoir des rapports sexuels avant le mariage et ont cru que les jeunes femmes ignorent les informations concernant le VIH et la prévention de la grossesse. Les MPS ont reconnu les facteurs extérieurs qui influent sur la capacité des jeunes femmes de se protéger. La plupart croyaient que les injectables constituaient la contraception la plus appropriée pour les jeunes femmes ; toutes les femmes reconnaissaient l’importance des préservatifs pour une double protection. Certains services ont été rendus aux femmes qui avaient plus de 18 ans. Les MPS peuvent profiter des ateliers qui donnent des informations sur les techniques et la politique ainsi que les exercices sur la clarification de valeurs qui ne mettent pas en lumière les influences des opinions sur l’assurance des services