Drinking Water Improvement Strategies and Childhood Diarrhea in a Poor Peri-urban Community in the Dominican Republic

Background: Diarrhea is a major cause of morbidity and mortality of children in low- and middle-income countries1-2. Contaminated drinking water is an important contributor to diarrheal   illness2-3. Point of use strategies for improving drinking water may be employed4-5, but the extent of use of different strategies and their relationship with childhood diarrhea is inadequately known outside of trial studies. Design and methodology: Caregivers of 199 children under the age of five participating in a child growth monitoring program based in a poor peri-urban community in the Dominican Republic agreed to participate in the study.  Caregivers were asked a series of drinking water questions at each growth monitoring appointment. Multiple responses per child were adjusted by weighting. Original data and results: Approximately 22% of children had diarrhea within 2 weeks of growth monitoring appointments. The most common water improvement strategy endorsed as “always” used for the child in the last four weeks was bottled water (53% ) followed by boiling (12%) and chlorination (6%). No reported strategy use was related to child diarrhea, including when stratified by age. Conclusion: Childhood diarrhea was higher in this community than the national average (14%)6.  High levels of bottled water use are consistent with high household level reports in the Dominican Republic. The lack of relationship between water improvement strategies and diarrhea was unexpected, although in some cases the strategy may have been implemented in response to childhood diarrhea. Analysis of child drinking water samples is required to assess the effectiveness of reported practices

Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999?2008 and 12/302 (4.0%) in 2009?2011 (P \u3c .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003?2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed

International Goals Made Local: A Case Study of HIV Reduction in the Dominican Republic

Honors (Bachelor's)International StudiesUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/120624/1/miravees.pd

Situation analysis of the integration of family planning services in postpartum, postabortion and prevention of mother to child transmission programs in the Dominican Republic

A diagnostic study of the provision and use of contraception in postpartum, postabortion, and prevention of mother-to-child transmission (PMTCT) programs in the Dominican Republic was conducted with funding from USAID. The objectives of the study were to assess the contraceptive knowledge, attitudes, and behaviors of providers and clients; the degree to which information, counseling, and delivery are implemented in postpartum, postabortion, and PMTCT services; the quality of these services; and the readiness of postpartum, postabortion, and PMTCT services to offer contraceptive services. The report finds that family planning services are linked to antenatal, delivery, and postpartum care in most of the health units visited and, to a lesser degree, to the integral care provided for persons living with HIV. These and other key findings were shared with the MOH directors of maternal and child health services and other stakeholders. Based on this project’s findings, the report lists key recommendations to improve postpartum and postabortion family planning services in the Dominican Republic

“I Feel Like More of a Man”: A Mixed Methods Study of Masculinity, Sexual Performance, and Circumcision for HIV Prevention

Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been no research on these dynamics among men who have received a circumcision for HIV prevention. We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected 6-12 months post-circumcision (N = 293) and in-depth interviews with a sub-sample of those men (n = 30). We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine (OR = 1.70, 95% CI: 1.25-2.32), feeling more potent erections post-circumcision (OR = 2.25, 95% CI: 1.26-4.03), and reporting increased ability to satisfy their partner post-circumcision (OR = 2.30, 95% CI: 1.11-4.77). In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one's partner and men's experiences of circumcision were shaped by social norms of masculinity. This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming

The Role of Masculine Gender Norms in HIV Vulnerability Among Dominican Men Enrolled in a Circumcision Feasibility Trial

Background: Masculine norms influence men’s sexual behaviors. Though this relationship has been extensively theorized, empirical evidence explaining this relationship is limited. This dissertation aims to understand how masculine norms and concern about demonstrating masculinity contribute to men’s HIV vulnerability in the Dominican Republic. Methods: I conducted three studies using qualitative and quantitative data from a feasibility trial of voluntary medical male circumcision for HIV prevention in two Dominican cities. In the first study, I analyzed survey data collected from men 6-12 months post-circumcision (n=293) to examine the association between Gender Role Conflict/Stress (i.e. concern about demonstrating masculine characteristics) and HIV-related sexual behaviors. In the second study, I analyzed data from in-depth interviews with a sub-sample of men in the trial (n=30) to explore how masculine norms shape men’s sexual and violent behaviors. Finally, in study three, I used both data sources to explore the relationships between norms of masculinity, male sexuality, and circumcision. Results: Men’s Gender Role Conflict/Stress was significantly associated with having two or more partners in the past 30 days, inconsistent condom use with non-steady partners, and drinking alcohol at last sex, after controlling for socio-demographic characteristics. In the qualitative interviews, men helped to explain this relationship by showing that masculine norms encouraged them to compete with one another for social status and that demonstrating masculine characteristics within their social networks – such as successful sexual performance or being a provider – was a key way to gain social status. Men were especially concerned about being humiliated because of the implications for losing status, which led to engaging in violence and sexual risk behaviors. Finally, nearly half of men reported feeling more masculine after receiving a circumcision. Their main reason for feeling more masculine was improved sexual performance which allowed them to avoid the humiliation associated with an inability to satisfy sexual partners. Conclusion: Men demonstrate their masculinity through their sexual behaviors and their concern about demonstrating masculine norms to their social network drives men’s HIV-related risk behaviors. HIV prevention efforts should ameliorate the negative effects of competition between men and address men’s concern about demonstrating masculine characteristics.Doctor of Philosoph

Adapting Global Service-Learning Project and Community Partnership Outcomes Using a “Tele-engineering” Approach in Response to the COVID-19 Pandemic

The Water Supply in Developing Countries (WSDC) service-learning course at Purdue University has fostered a strong partnership with the La Vega region in the Dominican Republic since 2012. During this time, an interdisciplinary group of engineering and science students has helped design drinking water treatment systems and the group has developed water, sanitation, and health (WASH) education materials. These WASH education and water safety approaches often have been conducted in person in the past. However, with the state of the COVID-19 pandemic and the inability to travel in the fall and spring semesters of the 2020–2021 academic year, the students have been exploring (1) the impact of the pandemic on the community schools in the La Vega province, (2) the impact of the pandemic on the current water treatment systems, and (3) possible solutions to implement a “virtual installation” of a water treatment system at our newest partner school in the community of Desecho. The coronavirus pandemic has ushered in a new way that we may approach our service-learning experiences in the future. More specifically, in the future, it may be more effective to serve as a “virtual consulting firm” of engineers and consultants, rather than builders, for the implementation and design of the water treatment systems. In this way, we may facilitate a partnership that fosters community agency and solution-based approaches to technical issues are led by local community members

Analysis of Multidimensional Inequalities in Central America and Dominican Republic, and a Strategy for Inequality Reduction

DEVCO, AFD, AECID and Oxfam Research ProjectBibliografía: p. 132-138Centroamérica y República Dominicana viven tiempos convulsos en lo político y en lo social y desafiantes en lo económico. En la base parece encontrarse la desigualdad, esto es, las brechas en la salud, la educación, el poder económico o el político que impiden que la mayoría de las personas acceda a los beneficios del desarrollo. Este informe intenta arrojar luz sobre estas brechas, identificando tendencias comunes en la región, analizando causas y proponiendo posibles soluciones. El informe ofrece una instantánea de las desigualdades, utilizando los datos más recientes disponibles para medirlas. Sin embargo, habida cuenta del contexto rápidamente cambiante de la subregión, los datos del presente informe no captan la situación de deterioro de muchas de las dimensiones analizadas, como resultado de las graves crisis sociales y políticas que afectan a la región y a los derechos humanos. Así ocurre en particular en el caso de Nicaragua, donde la mayoría de los datos disponibles son anteriores al estallido de la crisis de derechos humanos en abril de 2018.El equipo de Proyecto agradece la dirección y soporte de la Agencia Francesa de Desarrollo y de la Agencia Española de Cooperación para el Desarrollo, así como la contribución esencial de los equipos Oxfam, especialmente en los países implicados y en la región de Latinoamérica y el Caribe