Is household decision-making power associated with use of modern contraceptive methods among Jordanian women?

Background: In light of growing economic and resource-constraints and a stagnant total fertility rate of 3.5, the government of Jordan has doubled its efforts to improve uptake of contraceptive methods. To date, only qualitative studies have explored the socio-cultural and health system factors that influence use of family planning services. Objectives: To explore the relationship between autonomy-as measured through proxy household decision-making indicators-and the use of contraceptive methods in Jordan. Methods: Data from the 2012 Jordan Population and Family Health Survey (JPFHS) was used for this study. Multivariate logistic regression was used to examine the association between autonomy and contraceptive use controlling for confounders. Results: A total of 8,838 women were included in the study, 28% of whom were not currently using contraception despite citing a desire for spacing or limiting births. After controlling for confounders, women with a higher level of autonomy had 1.20 times the odds (95% CI: 1.07-1.35) of contraceptive use (traditional or modern methods) compared to women with low autonomy. Conclusion: Autonomy was associated with higher rates of contraceptive use, but not of use of modern contraceptive methods. Further exploration is warranted to better understand why autonomy is not predictive of modern contraceptive use.Master of Public Healt

Deux Langues, Deux Mondes? —Une étude de la situation littéraire actuelle de l’écrivain maghrébin bilingue

Since gaining Independence from France in 1962 and 1956 respectively, Algeria and Morocco have sought to reinstate the prestige of the Arabic language. French, however, has not completely been eliminated from the daily lives of the Maghreb population, and today the language of the colonizer remains closely associated with modernization and technology as well as subjects, such as sexuality, considered “taboo” by many Muslim societies. Conversely, Modern Standard Arabic and Classical Arabic, though rarely spoken in the informal daily setting, represent the universal language of the Arab people, as well as the language of Islam. This study examines the polemic of language choice in Maghreb literature in the 21st Century, demonstrating that the writer’s choice of language is circumscribed by extra-literary considerations (social and political) emanating from nationalist voices within his own country as well from Arab governments and their censorship laws, especially from Egypt, the publishing capital of the Arab world. In short, the suppression of spoken languages such as French and Maghrebi dialects by the post-Independence Arabization policies and subsequent failures in the education system evidenced by high illiteracy rates have prompted bilingual Maghreb authors to publish outside their respective countries. On a larger scale, the absence of an educated Arab public space and the censorship of many liberal texts have forced many Maghreb authors to write in French in an attempt to interact with a larger international community. Therefore, given the contemporary multilingual landscape of the Maghreb, this study questions the possibility and relevance of a “national literature” as defined by 19th century notion of a shared language, territory, and religion.Honors thesis - James Rolleston Prize for Best Honors Thesis written in a Foreign Languag

Determinación instrumental y sensorial del color de “magdalenas de chocolate” elaboradas con fibra de cacao como reemplazante de grasa

En el presente trabajo se ha utilizado fibra de cacao para sustituir de forma parcial la grasa de una formulación de magdalenas. Esta fibra aporta color “a chocolate” que puede aprovecharse como un valor añadido. Por esta razón, las magdalenas control (con la formulación completa en grasa) se han elaborado con cacao añadido para obtener “magdalenas de chocolate” y poder efectuar comparaciones sensorialmente válidas. Se estudió por tanto la correlación entre el color medido instrumental y sensorialmente de la muestra control con cacao y las magdalenas adicionadas con cantidades crecientes de fibra de cacao. El color resultó más parecido cuanto mayor fue la cantidad de fibra incorporada. Los resultados demostraron que la adición de esta fibra se puede considerar un ingrediente que aporta color similar al cacao en polvo y podría utilizarse para obtener magdalenas “de chocolate” bajas en grasa sin tener que adicionar cacao

Effect of self-administration versus provider-administered injection of subcutaneous depot medroxyprogesterone acetate on continuation rates in Malawi: a randomised controlled trial

Summary: Background: Injectable contraceptives are popular in sub-Saharan Africa but have high discontinuation rates due partly to the need for provider-administered re-injection. We compared continuation rates of women who self-injected subcutaneous depot medroxyprogesterone acetate (DMPA-SC) and women who received DMPA-SC from a health-care provider, including community health workers (CHWs). Methods: We did an open-label randomised controlled trial based at six Ministry of Health clinics in rural Mangochi District, Malawi. Health-care providers recruited adult women who presented at the six clinics or to CHWs in rural communities in the clinic catchment areas. Participants received DMPA-SC and were randomised (1:1) to receive provider-administered injections or training in how to self-inject DMPA-SC. Randomisation was done via a computer-generated block randomisation schedule with block sizes of four, six, and eight and stratified by study site, generated by an independent statistician. Self-injectors administered the first injection under observation and were sent home with three doses, written instructions, and a calendar. The provider-administered group received a DMPA-SC injection and a calendar, and were asked to return for subsequent injections. Data collectors contacted participants after the 14-week re-injection window at 3, 6, and 9 months to collect continuation data. At 12 months after enrolment or early discontinuation, women had their final interview, which included pregnancy testing. The primary outcome was discontinuation of DMPA-SC, as assessed in the intention-to-treat population. We used Kaplan-Meier methods to estimate the probabilities of continuation and a log-rank test to compare groups. Safety was assessed in the as-treated population, which consisted only of participants who successfully received at least one DMPA-SC injection after randomisation. This trial is registered with ClinicalTrials.gov, number NCT02293694. Findings: This study lasted from Sept 17, 2015, to Feb 21, 2017. 731 women underwent randomisation, with 364 assigned to the self-administered group and 367 to the provider-administered group. One woman in the self-injection group withdrew at month 0. Treatment was discontinued by 99 women in the self-administered group and 199 women in the provider-administered group. The 12 month continuation rate was 73% in the self-injection group and 45% in the provider-administered group, giving an incidence rate ratio of 0·40 (95% CI 0·31–0·51; p<0·0001). Adverse events deemed to potentially be treatment-related were reported by ten women (20 events) in the self-administered group and 17 women (28 events) in the provider-administered group. Five serious adverse events were reported during the trial by four women; two events related to DMPA-SC (menorrhagia and anaemia requiring hospital admission) were reported by the same woman in the provider-administered group and resolved without sequelae. The other serious adverse events, including one death, were deemed to be unrelated to DMPA-SC. Interpretation: Women who self-injected DMPA-SC had significantly higher rates of continuation than those receiving provider-injected DMPA-SC. Community-based provision of injectable contraception for self-injection in low-resource settings seems to be safe and feasible. Self-administration of DMPA-SC should be made widely available. Funding: United States Agency for International Development and Children's Investment Fund Foundation

Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature

<div><p>Introduction</p><p>Globally, an estimated 30% of new HIV infections occur among adolescents (15–24 years), most of whom reside in sub-Saharan Africa. Moreover, HIV-related mortality increased by 50% between 2005 and 2012 for adolescents 10–19 years while it decreased by 30% for all other age groups. Efforts to achieve and maintain optimal adherence to antiretroviral therapy are essential to ensuring viral suppression, good long-term health outcomes, and survival for young people. Evidence-based strategies to improve adherence among adolescents living with HIV are therefore a critical part of the response to the epidemic.</p><p>Methods</p><p>We conducted a systematic review of the peer-reviewed and grey literature published between 2010 and 2015 to identify interventions designed to improve antiretroviral adherence among adults and adolescents in low- and middle-income countries. We systematically searched PubMed, Web of Science, Popline, the AIDSFree Resource Library, and the USAID Development Experience Clearinghouse to identify relevant publications and used the NIH NHLBI Quality Assessment Tools to assess the quality and risk of bias of each study.</p><p>Results and discussion</p><p>We identified 52 peer-reviewed journal articles describing 51 distinct interventions out of a total of 13,429 potentially relevant publications. Forty-three interventions were conducted among adults, six included adults and adolescents, and two were conducted among adolescents only. All studies were conducted in low- and middle-income countries, most of these (n = 32) in sub-Saharan Africa. Individual or group adherence counseling (n = 12), mobile health (mHealth) interventions (n = 13), and community- and home-based care (n = 12) were the most common types of interventions reported. Methodological challenges plagued many studies, limiting the strength of the available evidence. However, task shifting, community-based adherence support, mHealth platforms, and group adherence counseling emerged as strategies used in adult populations that show promise for adaptation and testing among adolescents.</p><p>Conclusions</p><p>Despite the sizeable body of evidence for adults, few studies were high quality and no single intervention strategy stood out as definitively warranting adaptation for adolescents. Among adolescents, current evidence is both sparse and lacking in its quality. These findings highlight a pressing need to develop and test targeted intervention strategies to improve adherence among this high-priority population.</p></div

Improving retention in HIV care among adolescents and adults in low- and middle-income countries: A systematic review of the literature

<div><p>Introduction</p><p>Adolescents living with HIV are an underserved population, with poor retention in HIV health care services and high mortality, who are in need of targeted effective interventions. We conducted a literature review to identify strategies that could be adapted to meet the needs of adolescents living with HIV.</p><p>Methods</p><p>We searched PubMed, Web of Science, Popline, USAID’s AIDSFree Resource Library, and the USAID Development Experience Clearinghouse for relevant studies published within a recent five-year period. Studies were included if they described interventions to improve the retention in care of HIV-positive patients who are initiating or already receiving antiretroviral therapy in low- and middle-income countries. To assess the quality of the studies, we used the NIH NHLBI Study Quality Assessment Tools.</p><p>Results and discussion</p><p>Of 13,429 potentially relevant citations, 23 were eligible for inclusion. Most studies took place in sub-Saharan Africa. Only one study evaluated a retention intervention for youth (15–24 years); it found no difference in loss to follow-up between a youth-friendly clinic and a family-oriented clinic. A study of community-based service delivery which was effective for adults found no effect for youths. We found no relevant studies conducted exclusively with adolescent participants (10–19 years). Most studies were conducted with adults only or with populations that included adults and adolescents but did not report separate results for adolescents. Interventions that involved community-based services showed the most robust evidence for improving retention in care. Several studies found statistically significant associations between decentralization, down-referral of stable patients, task-shifting of services, and differentiated care, and retention in care among adults; however, most evidence comes from retrospective, observational studies and none of these approaches were evaluated among adolescents or youth.</p><p>Conclusions</p><p>Interventions that target retention in care among adolescents living with HIV are rare in the published literature. We found only two studies conducted with youth and no studies with adolescents. Given the urgent need to increase the retention of adolescents in HIV care, interventions that are effective in increasing adult retention in care should be considered for adaptation and evaluation among adolescents and interventions specifically targeting the needs of adolescents must be developed and tested.</p></div

Selection process for inclusion of studies.

<p>Selection process for inclusion of studies.</p

Summary of intervention types and inclusion age of study populations.

<p>Summary of intervention types and inclusion age of study populations.</p

Bhana et al., 2013.

<p>Bhana et al., 2013.</p

Characteristics of included studies.

<p>Characteristics of included studies.</p