Transactional sex risk across a typology of rural and urban female sex workers in Indonesia: a mixed methods study

Context-specific typologies of female sex workers (FSWs) are essential for the design of HIV intervention programming. This study develops a novel FSW typology for the analysis of transactional sex risk in rural and urban settings in Indonesia. Mixed methods include a survey of rural and urban FSWs (n = 310), in-depth interviews (n = 11), key informant interviews (n = 5) and ethnographic assessments. Thematic analysis categorises FSWs into 5 distinct groups based on geographical location of their sex work settings, place of solicitation, and whether sex work is their primary occupation. Multiple regression analysis shows that the likelihood of consistent condom use was higher among urban venue-based FSWs for whom sex work is not the only source of income than for any of the other rural and urban FSW groups. This effect was explained by the significantly lower likelihood of consistent condom use by rural venue-based FSWs (adjusted OR: 0.34 95% CI 0.13-0.90, p = 0.029). The FSW typology and differences in organisational features and social dynamics are more closely related to the risk of unprotected transactional sex, than levels of condom awareness and availability. Interventions need context-specific strategies to reach the different FSWs identified by this study's typology

Truancy and teenage pregnancy in English adolescent girls: can we identify those at risk?

BACKGROUND: Truancy has been linked to risky sexual behaviours in teenagers. However, no studies in England have examined the association between truancy and teenage pregnancy, and the use of truancy as a marker of teenagers at risk of pregnancy. METHODS: Using logistic regression, we investigated the association between truancy at age 15 and the likelihood of teenage pregnancy by age 19 among 3837 female teenagers who participated in the Longitudinal Study of Young People of England. We calculated the areas under the ROC curves of four models to determine how useful truancy would be as a marker of future teenage pregnancy. RESULTS: Truancy showed a dose-response association with teenage pregnancy after adjusting for ethnicity, educational intentions at age 16, parental socioeconomic status and family composition ('several days at a time' versus 'none', odds ratio 3.48 95% confidence interval 1.90-6.36, P < 0.001). Inclusion of risk behaviours improved the accuracy of predictive models only marginally (area under the ROC curve 0.76 full model versus 0.71 sociodemographic characteristics only). CONCLUSIONS: Truancy is independently associated with teenage pregnancy among English adolescent girls. However, the discriminatory powers of models were low, suggesting that interventions addressing the whole population, rather than targeting high-risk individuals, might be more effective in reducing teenage pregnancy rates.The work by Y.Z. is supported by an Academic Clinical Fellowship awarded by Health Education East of England (HEEoE). The work by D.I.P. is supported by the Economic and Social Science Research Council (ESRC) Grant ES.J004898.1.This is the final published version. It first appeared at http://dx.doi.org/10.1093/pubmed/fdv02

Development and evaluation of an online tool for management of overweight children in primary care: a pilot study.

OBJECTIVE: To explore the acceptability of implementing an online tool for the assessment and management of childhood obesity (Computer-Assisted Treatment of CHildren, CATCH) in primary care. DESIGN AND SETTING: An uncontrolled pilot study with integral process evaluation conducted at three general practices in northwest London, UK (November 2012-April 2013). PARTICIPANTS: Families with concerns about excess weight in a child aged 5-18 years (n=14 children). INTERVENTION: Families had a consultation with a doctor or nurse using CATCH, which assessed child weight status, cardiometabolic risk and risk of emotional and behavioural difficulties and provided personalised lifestyle advice. Families and practitioners completed questionnaires to assess the acceptability and usefulness of the consultation, and participated in semistructured interviews which explored user experiences. OUTCOME MEASURES: The primary outcome was family satisfaction with the tool-assisted consultation. Secondary outcomes were practitioners' satisfaction, and acceptability and usefulness of the intervention to families and practitioners. RESULTS: The majority of families (86%, n=12) and all practitioners (n=4) were satisfied with the consultation. Participants reported that the tool was easy to use, the personalised lifestyle advice useful and the use of visual aids beneficial. Families and practitioners identified a need for practical, structured support for weight management following the consultation. CONCLUSIONS: The results of this pilot study indicate that an online tool for assessment and management of childhood obesity can be implemented in primary care, and is acceptable to patients, families and practitioners. Further development and evaluation of the tool is warranted

The language of malaria in Abui: An interdisciplinary investigation of healthcare practices in Alor, Eastern Indonesia

We report on an interdisciplinary collaboration between public health experts, linguists, and botanists which seeks to better understand indigenous perspectives on malaria among the Abui [abz] speaking communities of Alor Island, Eastern Indonesia. Malaria is endemic in Alor and is highly resistant to common conventional treatment regimens (Sutanto et al. 2009). There is a low rate of compliance with modern malaria treatments, and a correspondingly high reliance on traditional treatment methods (Krentel 2008). Our research attempts to understand traditional knowledge of malaria in Abui and its relevance to modern healthcare. We analyze a corpus of unstructured interviews concerning health-related problems in Abui in order to better understand the conceptualization of disease (Forster 1976). This includes the systematic study of metaphor (Author 2016), sequencing of symptom descriptions (Author 2016), symptom-based indigenous classification of malaria, an inventory of traditional health-protecting practices, and an inventory of medical plants. The plant terminology reveals a syncretism between terms referring to diseases and the plants which either treat or cause those diseases. For example, the term takaya denotes both the ti plant (Cordyline fruticosa) and a severe form of malaria (Plasmodium falciparum). The leaves of the ti plant takaya are tied onto valuable trees such as candlenut, areca palm, and jackfruit to create a protective spell which wards off theft of the fruits or nuts of that tree. Transgressing this protection by taking the fruits or nuts without permission will cause the transgressor to suffer the takaya disease. The existence of supernatural causes may go unnoticed when interviews are conducted in Indonesian, the national language closely associated with modernity. However, the pervasiveness of plant-disease syncretism within Abui belies the continuing significance of traditional beliefs regarding disease. The collaborative methodology described here shows great promise for improving our understanding of the conceptualization of malaria in Abui and thus increasing treatment efficacy for this disease. Moreover, this approach provides a platform for documentary linguistics which includes a high level of community engagement. The healthcare interviews yield a culturally significant corpus of spontaneous speech which also serves as an independent knowledge base to evaluate the reliability and accuracy of ethnobotanical research. Finally, we suggest several ways in which our approach can be applied to future healthcare research in other domains and with other communities. References Author. 2016. The Pragmatics Behind the Medical and Health Knowledge in Alor: An Understanding of how disease is conceptualized in the Abui language. Honors thesis. Nanyang Technological University, Singapore. Du Bois, Cora. 1944. The People of Alor: a social-psychological study of an East Indian island. Minnesota: The University of Minnesota Press Forster, George M. 1976. Disease Etiologies in Non-Western Medical Systems. American Anthropologist 78(4): 773-782. Krentel, Alison. 2008. Why do individuals comply with mass drug administration for lymphatic filariasis? A case study from Alor District, Indonesia. PhD dissertation. London School of Hygiene & Tropical Medicine. Sutanto, I. Nurhayati, S. S., Manoempil, P., Baird, J.K. 2009. Resistance to Choloroquine by Plasmodium vivax at Alor in the Lesser Sundas Archipelago in Eastern Indonesia. The American Society of Tropical Medicine and Hygiene, 81(2), 338-342. Author. 2016. The Semantics of Complex Sentences in the Discourse of Health and Diseases: A Case Study in Abui. Honors thesis. Nanyang Technological University, Singapore

A cluster randomized controlled trial for assessing POC-CCA test based praziquantel treatment for schistosomiasis control in pregnant women and their young children: study protocol of the freeBILy clinical trial in Madagascar.

BACKGROUND: Mass drug administration (MDA) of praziquantel is one of the main control measures against human schistosomiasis. Although there are claims for including pregnant women, infants and children under the age of 5 years in high-endemic regions in MDA campaigns, they are usually not treated without a diagnosis. Diagnostic tools identifying infections at the primary health care centre (PHCC) level could therefore help to integrate these vulnerable groups into control programmes. freeBILy (fast and reliable easy-to-use-diagnostics for eliminating bilharzia in young children and mothers) is an international consortium focused on implementing and evaluating new schistosomiasis diagnostic strategies. In Madagascar, the study aims to determine the effectiveness of a test-based schistosomiasis treatment (TBST) strategy for pregnant women and their infants and children up until the age of 2 years. METHODS: A two-armed, cluster-randomized, controlled phase III trial including 5200 women and their offspring assesses the impact of TBST on child growth and maternal haemoglobin in areas of medium to high endemicity of Schistosoma mansoni. The participants are being tested with the point of care-circulating cathodic antigen (POC-CCA) test, a commercially available urine-based non-invasive rapid diagnostic test for schistosomiasis. In the intervention arm, a POC-CCA-TBST strategy is offered to women during pregnancy and 9 months after delivery, for their infants at 9 months of age. In the control arm, study visit procedures are the same, but without the POC-CCA-TBST procedure. All participants are being offered the POC-CCA-TBST 24 months after delivery. This trial is being integrated into the routine maternal and child primary health care programmes at 40 different PHCC in Madagascar's highlands. The purpose of the trial is to assess the effectiveness of the POC-CCA-TBST for controlling schistosomiasis in young children and mothers. DISCUSSION: This trial assesses a strategy to integrate pregnant women and their children under the age of 2 years into schistosomiasis control programmes using rapid diagnostic tests. It includes local capacity building for clinical trials and large-scale intervention research. TRIAL REGISTRATION: Pan-African Clinical Trial Register PACTR201905784271304. Retrospectively registered on 15 May 2019

Study population characteristics, stratified by urban and rural FSW populations (<i>n</i> = 310), 2007.

<p>Notes:</p>(a)<p><i>P</i> values obtained from Chi-square and Mann-Whitney U test.</p>(b)<p>Median age and inter-quartile range.</p

Unadjusted and adjusted odds ratios (ORs) for consistent condom use with clients, 2007.

(a)<p>The category ‘rural direct non-venue-based FSWs’ was excluded from this model due to its small sample size (n = 11). A model, which included this sub-group, resulted in large estimates signalling sparse-data bias within this categorical stratum, before and after adjustment (unadjusted OR: 1.9E⁻⁹ 95% CI 0 - ∞, p = 0.999; adjusted OR: 2.6E⁻⁹ 95% CI 0 - ∞, p = 0.999). This made it difficult to draw any definitive conclusions. Further, given the detail of the ethnography, there is reason to suspect that the rural non-venue-based FSW sample is not representative in statistical terms.</p>(b)<p>The categories divorced/separated and widowed were aggregated due to their similarity in the direction of effect.</p>(c)<p>1 USD = ca. IDR 9, 560.00 on 6 Sept 2012 according to <a href="http://www.xe.com/ucc/convert/?Amount=1&From=USD&To=IDR" target="_blank">http://www.xe.com/ucc/convert/?Amount=1&From=USD&To=IDR</a>. Here converted from IDR*1000 to USD (rounded up to IDR 10 000 per 1 USD).</p

Respondent characteristics and determinants of condom use, stratified by consistent and non-consistent condom users (<i>n</i> = 305), 2007.

<p> <b>Notes:</b></p>(a)<p><i>P</i> values obtained from Chi-square, Mann-Whitney U and Fisher's Exact tests as appropriate.</p>(b)<p>5 missing values, of which 4 reported to not know what a male condom is, and 1 who reported to not remember.</p>(c)<p>Median age and Interquartile Range (IQR).</p>(d)<p>4 missing values: 1 among the consistent users and 3 among the non-consistent users. 1 USD = ca. IDR 9, 560.00 on 6 Sept 2012 according to <a href="http://www.xe.com/ucc/convert/?Amount=1&From=USD&To=IDR" target="_blank">http://www.xe.com/ucc/convert/?Amount=1&From=USD&To=IDR</a> Here converted from IDR*1000 to USD (rounded up to IDR 10 000 per 1 USD).</p