Improving access to emergency contraception pills through strengthening service delivery and demand generation: A systematic review of current evidence in low and middle-income countries

© 2014 Dawson et al. Objectives: Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP.Methods: A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping.Findings: Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs.Conclusion: There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP

Workforce interventions to improve access to emergency contraception pills: A systematic review of current evidence in low- and middle-income countries and recommendations for improving performance Health systems and services in low and middle income settings

© 2015 Dawson et al.; licensee BioMed Central. Background: Emergency contraceptive pills (ECP) are one of the 13 essential commodities addressed by the UN Commission on Life-Saving Commodities for Women and Children. Although ECP have been available for 20 years, a number of barriers still limit women's access ECP in low and middle-income countries (LMIC). The workforce who prescribe or dispense ECP are diverse reflecting the varied contexts where ECP are available across the health, commercial and justice sectors and in the community. No reviews currently exist that examine the roles and experiences of the workforce that provide ECP in LMIC. Method: We present a narrative synthesis of research to: identify provider factors that facilitate and constraint access to ECP; assess the effectiveness of associated interventions and; explore associated health system issues in LMIC. A search of bibliographic databases, meta-indexes and websites was undertaken to retrieve peer reviewed and grey literature. Literature was screened and identified documents examined to appraise quality. Results: Thirty-seven documents were included in the review. Studies focused on formal health workers revealing knowledge gaps concerning the role of private sector and non-health providers who increasingly provide ECP. Data from the findings section in the documents were coded under 4 themes: provider knowledge; provider attitudes and beliefs; provider practice and provider training. The analysis revealed provider knowledge gaps, less than favourable attitudes and practice issues. The findings provide limited insight into products prescribed and/or dispensed, the frequency of provision, and information and advice offered to consumers. Pre and in-service training needs were noted. Conclusion: As the provision of ECPs shifts from the clinic-based health sector to increasing provision by the private sector, the limited understanding of provider performance and the practice gaps revealed in this review highlight the need to further examine provider performance to inform the development of appropriate workforce interventions. A standardized approach to assessing performance using agreed outcomes measures may serve to ensure a systematic way forward that is inclusive of the diverse workforce that deliver ECP. Recommendations are outlined to enhance the performance of providers to improve access to ECP. A framework is offered to help guide this process with indicators

Defence strategies and antibiotic resistance gene abundance in enterococci under stress by exposure to low doses of peracetic acid

partially_open12noPeracetic acid (PAA) is an organic compound used efficiently as disinfectant in wastewater treatments. Yet, at low doses it may cause selection; thus, the effect of low doses of PAA on Enterococcus faecium as a proxy of human-related microbial waste was evaluated. Bacteria were treated with increasing doses of PAA (from 0 to 25 mg L1 min) and incubated in regrowth experiments under non-growing, limiting conditions and under growing, favorable conditions. The changes in bacterial abundance, in bacterial phenotype (number and composition of small cell clusters), and in the abundance of an antibiotic resistance gene (ARG) was evaluated. The experiment demonstrated that the selected doses of PAA efficiently removed enterococci, and induced a long-lasting effect after PAA inactivation. The relative abundance of small clusters increased during the experiment when compared with that of the inoculum. Moreover, under growing favorable conditions the relative abundance of small clusters decreased and the number of cells per cluster increased with increasing PAA doses. A strong stability of the measured ARG was found, not showing any effect during the whole experiment. The results demonstrated the feasibility of low doses of PAA to inactivate bacteria. However, the stress induced by PAA disinfection promoted a bacterial adaptation, even if potentially without affecting the abundance of the ARG.openTurolla, Andrea; Sabatino, Raffaella; Fontaneto, Diego; Eckert, Ester M.; Colinas, Noemi; Corno, Gianluca; Citterio, Barbara; Biavasco, Francesca; Antonelli, Manuela; Mauro, Alessandro; Mangiaterra, Gianmarco; Di Cesare, AndreaTurolla, Andrea; Sabatino, Raffaella; Fontaneto, Diego; Eckert, Ester M.; Colinas, Noemi; Corno, Gianluca; Citterio, Barbara; Biavasco, Francesca; Antonelli, Manuela; Mauro, Alessandro; Mangiaterra, Gianmarco; Di Cesare, Andre

A twenty-year survey of dermatophytoses in Braga, Portugal

Modifications in social habits together with the increase of emigration have contributed not only to increased dermatophytoses but also to an altered etiology. During the last few years, Braga has suffered a radical change from a rural to a cosmopolitan life-style

Las categorías o facetas fundamentales: una metodología para el diseño de taxonomías corporativas de sitios Web argentinos

El análisis por facetas ha sido revaloado en los últimos años para el diseño de taxonomías corporativas. Con el fin de confirmar su utilidad, analizamos los sitios Web de diferentes organizaciones argentinas: tres bodegas de vino, tres industrias alimenticias, seis clubes de fútbol, cinco asociaciones profesionales, tres facultades universitarias y cinco agencias de gobierno. De las 16 categorías o facetas fundamentales propuestas por el Classification Research Group, las bodegas de vino coincidieron en 13 (81%), las industrias alimenticias en 11 (68%), los clubes de fútbol en 7 (43%), las asociaciones profesionales en 5 (31%), las facultades en 8 (50%) y las agencias de gobierno en 9 (56%). Estas diferencias se deben al hecho de que no todas las categorías son necesarias para todas las organizaciones. Se concluye que el método del análisis por facetas es útil para diseñar taxonomías corporativas y optimizar los sitios Web, de acuerdo con las características particulares de cada organización. Palabras claves Análisis de facetas; Taxonomías corporativas; Sítios Web argentinos. Fundamental categories or facets: a methodology for the design of corporate taxonomies of Argentinian web sites Abstract Faceted analysis has been reassessed in last years for designing corporative taxonomies. In order to confirm its usefulness, we analyzed the Web sites of different Argentine organizations: three wineries, three food industries, six football clubs, five professional associations, three university schools, and five government agencies. From the 16 fundamental categories or facets proposed by the Classification Research Group, wineries coincide in 13 (81%), food industries in 11 (68%), football clubs in 7 (43%), professional associations in 5 (31%), university schools in 8 (50%), and government agencies in 9 (56%). These differences are due to the fact that not all the categories are necessary for all organizations. We conclude that the method of faceted analysis is useful for designing corporative taxonomies and for optimizing Web sites, in accordance to particular characteristics of each organization. Keywords Faceted analysis; Corporative taxonomies; Argentine Web sites