Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, Mozambique

<p>Abstract</p> <p>Background</p> <p>Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.</p> <p>Methods</p> <p>In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed.</p> <p>Results</p> <p>An estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43% for contraception, 24% for counselling and testing and 23% for STI care). The average clinic running cost is US$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times.</p> <p>Conclusions</p> <p>Size of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.</p

Small individual loans and mental health: a randomized controlled trial among South African adults

<p>Abstract</p> <p>Background</p> <p>In the developing world, access to small, individual loans has been variously hailed as a poverty-alleviation tool – in the context of "microcredit" – but has also been criticized as "usury" and harmful to vulnerable borrowers. Prior studies have assessed effects of access to credit on traditional economic outcomes for poor borrowers, but effects on mental health have been largely ignored.</p> <p>Methods</p> <p>Applicants who had previously been rejected (n = 257) for a loan (200% annual percentage rate – APR) from a lender in South Africa were randomly assigned to a "second-look" that encouraged loan officers to approve their applications. This randomized encouragement resulted in 53% of applicants receiving a loan they otherwise would not have received. All subjects were assessed 6–12 months later with questions about demographics, socio-economic status, and two indicators of mental health: the Center for Epidemiologic Studies – Depression Scale (CES-D) and Cohen's Perceived Stress scale. Intent-to-treat analyses were calculated using multinomial probit regressions.</p> <p>Results</p> <p>Randomization into receiving a "second look" for access to credit increased perceived stress in the combined sample of women and men; the findings were stronger among men. Credit access was associated with reduced depressive symptoms in men, but not women.</p> <p>Conclusion</p> <p>Our findings suggest that a mechanism used to reduce the economic stress of extremely poor individuals can have mixed effects on their experiences of psychological stress and depressive symptomatology. Our data support the notion that mental health should be included as a measure of success (or failure) when examining potential tools for poverty alleviation. Further longitudinal research is needed in South Africa and other settings to understand how borrowing at high interest rates affects gender roles and daily life activities. CCT: ISRCTN 10734925</p

A Comparative Study of Endocervical and Pelvic Peritoneal Bacterial Flora in Infertile Women in Benin City, Nigeria

The relationship between the bacterial flora of the endocervix and the pelvic peritoneum in fifty infertile patients undergoing diagnostic laparoscopy and dye test was investigated at the University of Benin Teaching Hospital. The study design was prospective and cross-sectional. The setting was the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria. The study population was made up of fifty infertile subjects undergoing laparoscopic investigations. The results showed that there was no relationship between the bacterial colonies of the two studied anatomic sites in the subjects. However, a significant finding worthy of note to all clinicians were the two cases of Mycobacterium tuberculosis, which were isolated from both the endocervix and peritoneal cavities in the same patients. The other organisms isolated were of less clinical significance and were either only isolated from endocervix (82%), or the pelvic peritoneum [pouch of Douglas, (16%)]. It is concluded that there is no convincing scientific basis for the routine use of bacteriological investigation of the endocervix in the management of pelvic inflammatory disease (PID), and that pelvic tuberculosis may be more common than many clinicians presently believe. Sahel Medical Journal Vol.7(4) 2004: 107-10

Evaluation of Effect of Cannabis Smoking on the Hematological Properties of Selected Adult Male Students Smokers

The study investigated the effect of cannabis sativa smoking on some hematological characteristics on the male students consumers. Blood samples were collected in triplicates from twenty (10) randomly selected male voluntary marijuana smokers (test) and ten (10) voluntary male non-smokers (control) in Choba Community, Port Harcourt, Rivers State. The parameters considered were body temperature, pulse rate, Red blood cells (RBC) count, white blood cell (WBC) count, packed cell volume (PCV), erythrocyte sedimentation rate (ESR) and hemoglobin estimation (Hb). The research study revealed significant (p ≤ 0.05) differences in the hematological parameters between the smokers (Test) and non-smoker (control) subjects. Faster pulse rate and lower body temperatures were seen among test subjects as compared to control. The values observed for total white blood cell (TWBC), ESR and RBC were lower in test subject (smokers) than the control (non-smokers), while the values observed for ESR, Hb, and RBC were relatively close. The mean values observed for PCV, TWBC and Hb were markedly lower (p ≤ 0.05) in test subject than in control and could be indicative of reduced percentage of blood in the cell, porous immune system and decreased iron group of heme

The Use of National Youth Service Corp Members to Build AIDS Competent Communities in Rural Edo State Nigeria

This paper focuses on the community component of a larger action research project on HIV Prevention for Rural Youth (HP4RY), funded by the Global Health Research Initiative (Canada). It began with ethnographic research in 10 communities selected using geographic representative sampling and random assignment to one of three research arms. Using the AIDS Competent Community (ACC) model developed by Catherine Campbell, the ethnographic research identified factors in six domains that contributed to youth vulnerability to HIV infection. This was followed by recruitment, training and deployment of three overlapping cohorts of young adults (n=40) serving in Nigeria&#8217;s National Youth Service Corp (NYSC), to mobilize youth and adults in the communities to increase communities&#8217; AIDS competence over a nearly 2 year period. Monthly reports of these Corpers, observations of a Field Coordinator, and community feedback supported the conclusion that communities moved towards greater AIDS competence and reduction in youth vulnerability to HIV infection.&#160;Cet article se concentre sur la partie communautaire d&#8217;un plus grand projet de recherche d&#8217;action sur la prevention du VIH en faveur de la jeunesse rurale, financ&#233; par le Global Health Initiative (Canada). L&#8217;&#233;tude a commenc&#233; avec la recherche ethnographique dans 10 communaut&#233;s choisies &#224; l&#8217;aide d&#8217;un &#233;chantillon repr&#233;sentatif g&#233;ographique et une attribution al&#233;atoire &#224; une des trois sections de recherche. A l&#8217;aide du mod&#232;le de la Communaut&#233; Comp&#233;tente du SIDA (CCA), &#233;labor&#233; par Catherine Campbell, la recherche ethnographique a identifi&#233; des facteurs dans six domaines qui ont contribu&#233; &#224; la vuln&#233;rabilit&#233; des jeunes &#224; l&#8217;infection du VIH. Ensuite, il y a eu le recrutement, la formation et le d&#233;placement de trois cohortes de jeunes adultes qui se recoupent (n=40), engag&#233;s dans le service national de jeunes, pour mobiliser les jeunes et les adultes dans la communaut&#233; du SIDA au cours de d&#8217;environ deux ans. Des rapports mensuels de ces jeunes en service national, les observations d&#8217;un coordinateur sur le terrain et une r&#233;action communautaire ont soutenu la conclusion que les communaut&#233;s ont avanc&#233;e vers une meilleure comp&#233;tence du SIDA et une r&#233;duction dans la vuln&#233;rabilit&#233; des jeunes &#224; l&#8217;infection du VIH