Prevalence of Parasitaemia, Anaemia and treatment outcomes of Malaria among School Children in a Rural Community in Ghana

A cross-sectional survey was conducted in the Ejisu-Juaben District to determine the prevalence of asymptomatic malaria and anaemia, and treatment outcomes in pupils of seven public schools public schools in a rural community in the forest belt of Ghana. Children with confirmed malaria parasites were randomly assigned to be treated with Artemisinin-based combination therapies available on the Ghanaian market. Post-treatment days 14 and 28 follow-up blood samples were taken to determine the treatment outcomes on peripheral parasitaemia and haemoglobin (Hb) concentrations. Out of 812 pupils (without malaria symptoms) who were screened, the baseline parasitaemia prevalence was 58.6%. Parasitaemia prevalence across the seven (7) public schools ranged from 49.7% to 71.0% (p =0.002). Post-treatment parasitaemia among the different treatment regimes were significant only at day 28 (p<0.001). The mean Hb concentration on the screening day was 10.5g/dl and over 60% of pupils were mildly anaemic (Hb <11.0g/dl) whereas 14% had Hb <8.0g/dl. Post-treatment Hb concentrations of pupils by days 14 and 28 were 11.4g/dl and 11.7g/dl with an improvement of 0.7g/dl and 0.9g/dl respectively over the baseline Hb concentration (p<0.001). The overall proportion of children with Hb concentrations <11.0g/dl was 32.6% and 25.3% by days 14 and 28 respectively. The burden of malaria and anaemia among school children is high and warrants investment to reduce these levels. These findings could be a reflection of the health situation that pertains in the basic public schools especially in the rural forest areas of Ghana.Keywords: asymptomatic malaria, parasitaemia, anaemia, pupils, rural Ghan

“I Get Angry If He's Always Drinking and We Have No Money”: Exploring Motivations for Male and Female Perpetrated Intimate Partner Violence in the Philippines

Our objective was to describe the context of and motivations for female and male perpetrated IPV in Cebu, Philippines using data from in-depth interviews with 19 married women. We found three categories of IPV motivations --self-defense or retaliation, reactivity, and control. Motivations differed by gender, with women acting out of self-defense more often and men acting out of control more often. Effective IPV prevention and treatment programs should take these gender differences into consideration. Moreover, it is important to look at how IPV occurs within relationships and how this may vary by context and gender

Research priorities for adolescent health in low- and middle-income countries: A mixed-methods synthesis of two separate exercises.

BACKGROUND: In order to clarify priorities and stimulate research in adolescent health in low- and middle-income countries (LMICs), the World Health Organization (WHO) conducted two priority-setting exercises based on the Child Health and Nutrition Research Initiative (CHNRI) methodology related to 1) adolescent sexual and reproductive health and 2) eight areas of adolescent health including communicable diseases prevention and management, injuries and violence, mental health, non-communicable diseases management, nutrition, physical activity, substance use, and health policy. Although the CHNRI methodology has been utilized in over 50 separate research priority setting exercises, none have qualitatively synthesized the ultimate findings across studies. The purpose of this study was to conduct a mixed-method synthesis of two research priority-setting exercises for adolescent health in LMICs based on the CHNRI methodology and to situate the priority questions within the current global health agenda. METHODS: All of the 116 top-ranked questions presented in each exercise were analyzed by two independent reviewers. Word clouds were generated based on keywords from the top-ranked questions. Questions were coded and content analysis was conducted based on type of delivery platform, vulnerable populations, and the Survive, Thrive, and Transform framework from the United Nations Global Strategy for Women's, Children's, and Adolescents' Health, 2016-2030. FINDINGS: Within the 53 top-ranked intervention-related questions that specified a delivery platform, the platforms specified were schools (n = 17), primary care (n = 12), community (n = 11), parenting (n = 6), virtual media (n = 5), and peers (n = 2). Twenty questions specifically focused on vulnerable adolescents, including those living with HIV, tuberculosis, mental illness, or neurodevelopmental disorders; victims of gender-based violence; refugees; young persons who inject drugs; sex workers; slum dwellers; out-of-school youth; and youth in armed conflict. A majority of the top-ranked questions (108/116) aligned with one or a combination of the Survive (n = 39), Thrive (n = 67), and Transform (n = 28) agendas. CONCLUSIONS: This study advances the CHNRI methodology by conducting the first mixed-methods synthesis of multiple research priority-setting exercises by analyzing keywords (using word clouds) and themes (using content analysis)

Abortion experiences among Zanzibari women: a chain-referral sampling study

Abstract Background In Zanzibar, a semi-autonomous region of Tanzania, induced abortion is illegal but common, and fewer than 12 % of married reproductive-aged women use modern contraception. As part of a multi-method study about contraception and consequences of unwanted pregnancies, the objective of this study was to understand the experiences of Zanzibari women who terminated pregnancies. Methods The cross-sectional study was set in Zanzibar, Tanzania. Participants were a community-based sample of women who had terminated pregnancies. We carried out semi-structured interviews with 45 women recruited via chain-referral sampling. We report the characteristics of women who have had abortions, the reasons they had abortions, and the methods used to terminate their pregnancies. Results Women in Zanzibar terminate pregnancies that are unwanted for a range of reasons, at various points in their reproductive lives, and using multiple methods. While clinical methods were most effective, nearly half of our participants successfully terminated a pregnancy using non-clinical methods and very few had complications requiring post abortion care (PAC). Conclusions Even in settings where abortion is illegal, some women experience illegal abortions without adverse health consequences, what we might call ‘safer’ unsafe abortions; these kinds of abortion experiences can be missed in studies about abortion conducted among women seeking PAC in hospitals

Preserved differentiation between physical activity and cognitive performance across young, middle, and older adulthood over 8 years.

Objectives: A critical question in the activity engagement literature is whether physical exercise alters the trajectory of age-related cognitive decline (differential preservation) or is associated with enhanced baseline cognitive ability (preserved differentiation). Further, investigations considering that these relations may differ across young, middle, and older adulthood are rare. Method: We evaluated data from the PATH Through Life Project, where participants aged 20-24, 40-44, and 60-64 years at baseline (n = 6,869) completed physical activity (PA; mild, moderate, and vigorous) and cognitive measurements thrice over 8 years. Results: Multilevel models accounting for employment status, sex, education, health, and mental and social activity showed that between-person differences in PA participation positively predicted baseline performance on fluid cognitive ability (perceptual speed, short-term memory, working memory, and episodic memory). These effects were similar across age groups, but strongest for the youngest cohort, for whom there was also evidence of covariation between within-person change in PA and cognitive score. PA was not associated with change in cognition over time. DISCUSSION: Results support preserved differentiation, where physically active adults have higher initial cognitive ability, and the advantage is maintained over time. PA appears to be unique in showing differences across young, middle, and older adulthood in predicting cognition

Exploring the effectiveness of the output-based aid voucher program to increase uptake of gender-based violence recovery services in Kenya: a qualitative evaluation

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Few studies in Africa have explored in detail the ability of output-based aid (OBA) voucher programs to increase access to gender-based violence recovery (GBVR) services. Methods: A qualitative study was conducted in 2010 and involved: (i) in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and (ii) focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five program sites in Kenya. Results: The findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services. These include lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. Moreover, accreditation of only hospitals to offer GBVR services undermines access to the services in rural areas. Poor responsiveness from law enforcement agencies and fear of reprisal from perpetrators also undermine treatment options and access to medical services. Low provider knowledge on GBVR services and lack of supplies also affect effective provision and management of GBVR services. Conclusions: The above findings suggest that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA program to promote the GBVR services voucher, and conduct widespread community education programs aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers.The Bill and Melinda Gates Foundatio

Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) Study: formative protocol for mHealth platform development and piloting

BackgroundThere is a high unmet need for sexual and reproductive health (SRH) information and services among youth (ages 15-24) worldwide (MacQuarrie KLD. Unmet Need for Family Planning among Young Women: Levels and Trends 2014). With the proliferation of mobile technology, and its popularity with this age group, mobile phones offer a novel and accessible platform for a discreet, on-demand service providing SRH information. The Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) formative study will inform the development of an intervention, which will use the popular channel of SMS (text messages) to deliver SRH information on-demand to youth.Methods/DesignFollowing the development of potential SMS message content in partnership with SRH technical experts and youth, formative research activities will take place over two phases. Phase 1 will use focus group discussions (FGDs) with youth and parents/caregivers to develop and test the appropriateness and acceptability of the SMS messages. Phase 2 will consist of ‘peer piloting’, where youth participants will complete an SRH outcome-focused pretest, be introduced to the system and then have three weeks to interact with the system and share it with friends. Participants will then return to complete the SRH post-test and participate in an in-depth interview about their own and their peers’ opinions and experiences using ARMADILLO.DiscussionThe ARMADILLO formative stage will culminate in the finalization of country-specific ARMADILLO messaging. Reach and impact of ARMADILLO will be measured at later stages. We anticipate that the complete ARMADILLO platform will be scalable, with the potential for national-level adoption

EXTREME TEMPERATURE AND EXTREME VIOLENCE: EVIDENCE FROM RUSSIA

We study the relationship between extreme temperatures and violent mortality, employing novel regional panel data from Russia. We find that extremely hot temperatures increase violent mortality, while extremely cold temperatures have no effect. The impact of hot temperature on violence is unequal across gender and age groups, rises noticeably during weekends, and leads to considerable social costs. Our findings also suggest that better job opportunities and lower vodka consumption may decrease this impact. The results underscore that economic policies need to target vulnerable population groups to mitigate the adverse impact of extreme temperatures. (JEL Q54, I14, K42). © 2020 The Authors. Economic Inquiry published by Wiley Periodicals LLC on behalf of Western Economic Association International.The authors thank Jason Lindo (co‐editor), three anonymous referees, Richard Frensch, Ali Kutan, Igor Makarov, Milena Nikolova, Mariola Pytlikova, and participants at the ASSA 2019 meeting in Atlanta, IOS/APB/EACES summer academy in Tutzing, and research seminars at IOS Regensburg, Curtin University, and the Laboratory for Economics of Climate Change at HSE Moscow for valuable comments. The authors acknowledge the support from Russian Science Foundation (RSCF) grant no. 19‐18‐00262

On-going collaborative priority-setting for research activity: a method of capacity building to reduce the research-practice translational gap

Background: International policy suggests that collaborative priority setting (CPS) between researchers and end users of research should shape the research agenda, and can increase capacity to address the research-practice translational gap. There is limited research evidence to guide how this should be done to meet the needs of dynamic healthcare systems. One-off priority setting events and time-lag between decision and action prove problematic. This study illustrates the use of CPS in a UK research collaboration called Collaboration and Leadership in Applied Health Research and Care (CLAHRC). Methods: Data were collected from a north of England CLAHRC through semi-structured interviews with 28 interviewees and a workshop of key stakeholders (n = 21) including academics, NHS clinicians, and managers. Documentary analysis of internal reports and CLAHRC annual reports for the first two and half years was also undertaken. These data were thematically coded. Results: Methods of CPS linked to the developmental phase of the CLAHRC. Early methods included pre-existing historical partnerships with on-going dialogue. Later, new platforms for on-going discussions were formed. Consensus techniques with staged project development were also used. All methods demonstrated actual or potential change in practice and services. Impact was enabled through the flexibility of research and implementation work streams; ‘matched’ funding arrangements to support alignment of priorities in partner organisations; the size of the collaboration offering a resource to meet project needs; and the length of the programme providing stability and long term relationships. Difficulties included tensions between being responsive to priorities and the possibility of ‘drift’ within project work, between academics and practice, and between service providers and commissioners in the health services. Providing protected ‘matched’ time proved difficult for some NHS managers, which put increasing work pressure on them. CPS is more time consuming than traditional approaches to project development. Conclusions: CPS can produce needs-led projects that are bedded in services using a variety of methods. Contributing factors for effective CPS include flexibility in use and type of available resources, flexible work plans, and responsive leadership. The CLAHRC model provides a translational infrastructure that enables CPS that can impact on healthcare systems