Facilitating regulatory approval of multipurpose prevention technologies for sexual and reproductive health

This brief describes multipurpose prevention technologies (MPTs) that address women\u27s sexual and reproductive health (SRH) needs, and how to go about facilitating regulatory approval of this technology. It outlines a strategic framework to examine current regulatory guidance, as well a product development pathway to bring MPTs to market

Taking programs for vulnerable adolescents to scale: Experiences, insights, and evidence

The international development community’s desire to alleviate poverty and improve health outcomes presents an extraordinary opportunity to transform the lives of young people, particularly girls. Cycles of illiteracy, poor job prospects, and social isolation can be broken but will require concerted efforts to reach large numbers of vulnerable adolescent girls with robust asset-building programs. Scaling-up effective pilot programs will be critical to achieving these goals. While there is an expanding body of research around scaling up health interventions, less is known or documented about scaling up cross-sectoral programs for adolescent girls. Bringing to scale programs directed toward poor, often invisible and voiceless girls, poses unique challenges. Given that this is a relatively new field at an early stage of experimentation, the evidence base regarding which strategies are most effective is still emerging. The Population Council has been exploring a variety of approaches to meet these challenges in diverse settings and gathering evidence to inform program and policy development, as detailed in Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 36

Leveling the playing field: Building girls\u27 sports programs and creating new opportunities

From Afghanistan to Zimbabwe, more girls and women are participating in sports than ever before. Even in the most unlikely settings, girls are stepping onto playing fields, joining teams, and participating in ways that were unprecedented a decade ago. The burgeoning interest in girls’ and women’s sports around the globe provides an opportune moment to examine the role of sports in adolescent girls’ lives and build the evidence base for future programming and policy development. This brief reports on the collaboration between Population Council researchers and partners, including sports organizations, women’s groups, international development agencies, and ministries of youth, in helping shape and evaluate innovative programs for adolescent girls. There is a growing consensus that sports can play a meaningful role in girls’ lives. Beyond the clear physical and health benefits, participation in sports programs provides girls with the opportunity to develop new skills, to learn and lead, and to expand and deepen social support networks

Scaling up asset-building programs for marginalized adolescent girls in socially conservative settings: The Ishraq program in rural Upper Egypt

In 2001, the Population Council and partners designed and implement an intervention program to address the needs of out-of-school adolescent girls in rural Upper Egypt. As noted in Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 12, the pilot, referred to as Ishraq (“Sunrise”), was launched in four rural villages of el-Minya governorate in Upper Egypt, the country’s least developed and most disadvantaged region. Targeting girls aged 13–15, this program was designed to promote literacy, impart life skills, build social networks, and foster leadership and self-confidence through sports. By establishing girl-friendly spaces in which participants could meet, learn, play, and work collectively, the program sought to safely and confidently bring girls into the public space. At the same time, related interventions aimed at girls’ gatekeepers—parents, boys, and community leaders—were designed to initiate change in community norms and beliefs about the capacities and roles of girls in society. The program currently targets girls 13–15 years of age, but younger girls benefit from the program as well

Elevated PAI-1 is associated with poor clinical outcomes in pediatric patients with acute lung injury.

PurposeDeposition of fibrin in the alveolar space is a hallmark of acute lung injury (ALI). Plasminogen activator inhibitor-1 (PAI-1) is an antifibrinolytic agent that is activated during inflammation. Increased plasma and pulmonary edema fluid levels of PAI-1 are associated with increased mortality in adults with ALI. This relationship has not been examined in children. The objective of this study was to test whether increased plasma PAI-1 levels are associated with worse clinical outcomes in pediatric patients with ALI.Design/methodsWe measured plasma PAI-1 levels on the first day of ALI among 94 pediatric patients enrolled in two separate prospective, multicenter investigations and followed them for clinical outcomes. All patients met American European Consensus Conference criteria for ALI.ResultsA total of 94 patients were included. The median age was 3.2 years (range 16 days-18 years), the PaO(2)/F(i)O(2) was 141 +/- 72 (mean +/- SD), and overall mortality was 14/94 (15%). PAI-1 levels were significantly higher in nonsurvivors compared to survivors (P < 0.01). The adjusted odds of mortality doubled for every log increase in the level of plasma PAI-1 after adjustment for age and severity of illness.ConclusionsHigher PAI-1 levels are associated with increased mortality and fewer ventilator-free days among pediatric patients with ALI. These findings suggest that impaired fibrinolysis may play a role in the pathogenesis of ALI in pediatric patients and suggest that PAI-1 may serve as a useful biomarker of prognosis in patients with ALI

Investing When It Counts: Reviewing the Evidence and Charting a Course of Research and Action for Very Young Adolescents

Since 2006, there has been a burgeoning interest in the very young adolescent population and an ever-expanding array of programs aimed at addressing their social, health, and development needs. This report builds on the momentum generated from recent research and program efforts, and from the greater data available in the past decade. The report is intended to be helpful to anyone who plans, manages, implements, monitors, evaluates, or funds research or programs that involve young adolescent girls and boys. The report outlines several key areas that would benefit from more experimentation and new research. Central to this is the creation of community platforms/meeting places—places for skill building and safe engagement, especially for girls whose social space is already confined and in many cases shrinking

Insights and evidence gaps in girl-centered programming: A systematic review

Increased attention to the needs of adolescent girls has led to a growing number of programs in low- and middle-income countries. Questions remain, however, about what aspects of program design are most effective. This hinders efforts to effectively allocate resources, scale up programs, and replicate results across settings. This review looks at how the number of program components, involvement of supporting actors who influence the lives of girls, supplemental “booster” activities, intervention exposure level, and community saturation level influenced outcomes for girls. While findings suggest the importance of multicomponent programs and longer program exposure, each area requires further rigorous research to determine whether and under what circumstances they amplify impact

Calling attention to young adolescents: Building the evidence base to inform policies and programs

Young adolescence is a critical life-cycle stage marked by a dynamic combination of opportunity and risk. During this time, children undergo tremendous physical, emotional, social, and cognitive changes as well as socialization into prevailing sexual and gender norms. For the majority, young adolescence is characterized by relatively good health and stable family circumstances, but it can also be a period of vulnerability due to a number of rapid transitions that force some young people into adult roles. Most young adolescents experience the onset of puberty (girls earlier than boys), which typically marks an abrupt life change. Some young adolescents will experience their first sexual encounter, which may not be volitional. Other transitions may include leaving school, entering the labor force, moving away from or losing parents, and early marriage. Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 37 explores adolescents as a neglected population for research, programming, and advocacy; fostering of research and program experimentation by the Population Council; implications for policy, programs, and research; and areas for future work

Female-Initiated Prevention Methods (FIPM) in Kenya: Focus on the female condom

As noted in this brief, the female condom (FC) is the only female-initiated prevention product that provides simultaneous protection against pregnancy and sexually transmitted infections, including HIV. Although available for more than a decade, the FC remains limited in supply, not readily available, and underutilized. Obstacles to widespread availability and use are often generalized (e.g., high costs, resistance of partners, or unavailability). With the upcoming second generation of FCs—and ultimately microbicides—being added to female-initiated prevention methods, the need to overcome these impediments with concrete solutions is critical. Government and donor commitment to long-term, sustained supply and program support is essential. The Population Council will generate evidence through innovative program experimentation and by mapping the FC landscape in Kenya. Acceptability of the FC to users has been established through research in many countries, but no effort has been made to compare different programmatic delivery mechanisms and service delivery models. The Female-Initiated Prevention Methods project explores the appropriateness, feasibility, and effectiveness of three different means of delivering FC services in Kenya. Findings will inform a more acceptable delivery of FC to Kenyan women

Constructing a critical path for product development, commercialization, and access

This brief discusses the Council\u27s health technologies development and the product development path from conceptualization to market. It defines the steps in the Critical Path Framework, and examines activities at the preclinical and clinical stage