Hearing the silences: adult Nigerian women’s accounts of ‘early marriages’

‘Early marriage’ is a relatively common, but under-researched global phenomenon, associated with poor health, mental health, educational and occupational outcomes, particularly for young girls. In this article, we draw on qualitative interviews with 6 Nigerian women from Sokoto State, who were married between the ages of 8 and 15. The interviews explored young women’s experiences of the transition to marriage, being married, pregnancy and their understanding of the marital and parental role. Using Interpretive Phenomenological Analysis, we explore women’s constrained articulations of their experiences of early marriage, as they are constituted within a social context where the identity of ‘woman’ is bound up in values and practices around marriage and motherhood. We explore the complexity of ‘hearing’ women’s experiences when their identities are bound up in culturally overdetermined ideas of femininity that function explicitly to silence and constrain the spaces in which women can speak

Indicators for Women's Health in Developing Countries: What They Reveal and Conceal

Summary The health of women has recently resurfaced in the health policy debate and has tended to become viewed as important primarily because of its contribution to infant health. Maternal deaths are characterised by a range of fairly typical causes, all of which can normally be prevented with good obstetric medical services and antenatal care. The most widely used indicator, the maternal mortality rare, is closely associated with a range of socioeconomic determinants; most notably poverty and access to obstetric services, which suggests that medicine alone cannot solve the whole problem. Factors such as urbanization, female secondary education, contraceptive prevalence and fertility all appear to be important intermediate determinants, which highlight the fact that the problem is really rooted in a much wider one of the status and role of women in development. The indicator of the maternal mortality rate itself actually underestimates the true impact of fertility on women's health. The indicator of lifetime risk (of dying in childbirth) is much more relevant and it provides an even starker picture of differentials in health risks, and the role fertility plays in these risks. It puts fertility back into women's health and the object of measurement is women's lives rather than the disembodied event of birth. Resumé Indicateurs de la santé des femmes dans les pays en voie de développement: ce qu'ils révèlent et ce qu'ils cachent Le sujet de la santé des femmes remonte à la surface dans le débat concernant les politiques de santé; ce sujet a été censé important, du moins récemment, en raison principalement de sa contribution à la santé infantile. Les décès maternels sont caractérisés par une gamme de causes relativement typiques et qu'il est normalement possible d'éviter moyennant une bonne obstétrique médicale et des soins adéquats en période prénatale. L'indicateur le plus fréquemment employé, le taux de mortalité maternel, est étroitement lié à une gamme de déterminants socio?économiques, notamment la pauvreté et l'accès aux services obstétriques, qui suggèrent que l'accès à la médecine seule ne peut entièrement résoudre le problème. Les facteurs tels que l'urbanisation, l'enseignement secondaire des femmes, la disponibilité de la contraception et la fécondité sembleraient tous être des indicateurs d'ordre intermédiaire, et ceci aurait tendance à souligner le fait que le problème véritable est effectivement encastré dans un problème encore plus grave, à savoir celui du rôle et de la situation des femmes dans le développement. L'indicateur de mortalité maternelle sous?estime en fait l'impact véritable de la fertilité sur la santé des femmes. L'indicateur de risque à longueur de vie (de mourir durant un accouchement) est beaucoup plus approprié et offre une image encore plus déprimante des différentiels dans les risques à la santé, et du rôle que la fertilité joue dans ces risques. Cet indicateur remet en cause la fertilité au sein de la santé des femmes et en fait une mesure de la vie des femmes, à la place du simple événement qu'est tel ou tel accouchement. Resumen Indicadores de salud femenina en los países en desarrollo: lo que revelan y lo que ocultan El tema de la salud de la mujer ha resurgido recientemente en el debate sobre directivas de salud, y la tendencia ha sido considerarlo importante primordialmente por su contribución a la salud infantil. Las muertes maternales tienen una serie de causas bastante típicas, todas las cuales pueden normalmente ser evitadas con buenos servicios obstétricos y cuidados prenatales. El indicator más usado, la tasa de mortalidad maternal, está asociado a los determinantes socioeconómicos, notablemente la pobreza y la falta de acceso a los servicios ginecológicos, lo que sugiere que la medicina no puede resolver todo el problema por sí sola. Factores como la urbanización, la educación secundaria femenina, la prevalencia anticonceptiva y la fertilidad parecen ser importantes determinantes intermedios, y eso destaca el hecho de que el problema está realmente enraizado en otro mucho mas amplio: la condición y el papel de la mujer en el desarrollo. El indicador de la tasa de mortalidad maternal en realidad subestima el verdadero impacto de la fertilidad en la salud femenina. El indicador de riesgo vital: muerte de parto es mucho más significativo y da una imagen aún más severa de los diferenciales en riesgos de salud y el papel jugado por la fertilidad en esos riesgos. Pone a la fertilidad dentro de la salud femenina nuevamente, y lo que se mide es la vida de la mujer en vez del evento aislado del parto

The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe

Peer reviewedPublisher PD

NUTRItion and CLIMate (NUTRICLIM): investigating the relationship between climate variables and childhood malnutrition through agriculture, an exploratory study in Burkina Faso

Malnutrition remains a leading cause of death in children in low- and middle-income countries; this will be aggravated by climate change. Annually, 6.9 million deaths of children under 5 were attributable directly or indirectly to malnutrition. Although these figures have recently decreased, evidence shows that a world with a medium climate (local warming up to 3–4 °C) will create an additional 25.2 million malnourished children. This proof of concept study explores the relationships between childhood malnutrition (more specifically stunting), regional agricultural yields, and climate variable through the use of remote sensing (RS) satellite imaging along with algorithms to predict the effect of climate variability on agricultural yields and on malnutrition of children under 5. The success of this proof of purpose study, NUTRItion and CLIMate (NUTRICLIM), should encourage researchers to apply both concept and tools to study of the link between weather variability, crop yield, and malnutrition on a larger scale. It would also allow for linking such micro-level data to climate models and address the challenge of projecting the additional impact of childhood malnutrition from climate change to various policy relevant time horizons

Prevalence and factors associated with non-utilization of healthcare facility for childbirth in rural and urban Nigeria: Analysis of a national population-based survey

Aim: The aim of this study was to assess the rural–urban differences in the prevalence and factors associated with non-utilization of healthcare facility for childbirth (home delivery) in Nigeria. Methods: Dataset from the Nigeria demographic and health survey, 2013, disaggregated by rural–urban residence were analyzed with appropriate adjustment for the cluster sampling design of the survey. Factors associated with home delivery were identified using multivariable logistic regression analysis. Results: In rural and urban residence, the prevalence of home delivery were 78.3% and 38.1%, respectively (p < 0.001). The lowest prevalence of home delivery occurred in the South-East region for rural residence (18.6%) and the South-West region for urban residence (17.9%). The North-West region had the highest prevalence of home delivery, 93.6% and 70.5% in rural and urban residence, respectively. Low maternal as well as paternal education, low antenatal attendance, being less wealthy, the practice of Islam, and living in the North-East, North-West and the South-South regions increased the likelihood of home delivery in both rural and urban residences. Whether in rural or urban residence, birth order of one decreased the likelihood of home delivery. In rural residence only, living in the North-Central region increased the chances of home delivery. In urban residence only, maternal age ⩾ 36 years decreased the likelihood of home delivery, while ‘Traditionalist/other’ religion and maternal age < 20 years increased it. Conclusion: The prevalence of home delivery was much higher in rural than urban Nigeria and the associated factors differ to varying degrees in the two residences. Future intervention efforts would need to prioritize findings in this study

School tuck shops in South Africa—an ethical appraisal

It can be postulated that schools have an ethical responsibility to protect children from an unhealthy food environment. Against the backdrop of stunting, overweight and micronutrient deficiencies prevalent in South African children, the aim of this scoping study is to review information available on foods sold to school children within an ethical framework. While some schools have a formal tuck shop, at other schools, food vendors sell food either on or outside the school premises. Ten studies, of which two were national, fit the selection criteria for this study. Available data show that mostly unhealthy food options are sold to South African school children; with low-nutrient energy-dense foods (e.g. chips, sweets) and sugar sweetened beverages being the most popular. The Integrated School Health Policy provide a policy framework for achieving healthy school food environments in South Africa, and several guidelines are available in South African to assist school tuck shops to sell healthier options. Children’s preference for unhealthy foods, the cost of healthier food options and a lack of proper facilities may however be barriers for implementing healthy tuck shops. An action stronger than merely providing guidelines may therefore be needed. Cognisance needs to be taken of conflicting value based arguments within ethical perspectives. Given these conflicts, the authors argue that an Ethics of Responsibility contributes to the debate of the best and supports the notion that society at large has a responsibility to protect vulnerable communities of which school children are part. Presently an ethical vacuum exists in terms of rights and responsibilities which this study hopes to address.DHE

Measuring maternal mortality : an overview of opportunities and options for developing countries

Background:There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015. Methods: Since the launch of the Safe Motherhood Initiative in 1987, new opportunities for data capture have arisen and new methods have been developed, tested and used. This paper provides a pragmatic overview of these methods and the optimal measurement strategies for different developing country contexts. Results: There are significant recent advances in the measurement of maternal mortality, yet also room for further improvement, particularly in assessing the magnitude and direction of biases and their implications for different data uses. Some of the innovations in measurement provide efficient mechanisms for gathering the requisite primary data at a reasonably low cost. No method, however, has zero costs. Investment is needed in measurement strategies for maternal mortality suited to the needs and resources of a country, and which also strengthen the technical capacity to generate and use credible estimates. Conclusion: Ownership of information is necessary for it to be acted upon: what you count is what you do. Difficulties with measurement must not be allowed to discourage efforts to reduce maternal mortality. Countries must be encouraged and enabled to count maternal deaths and act.WJG is funded partially by the University of Aberdeen. OMRC is partially funded by the London School of Hygiene and Tropical Medicine. CS and SA are partially funded by Johns Hopkins University. CAZ is funded by the Health Metrics Network at the World Health Organization. WJG, OMRC, CS and SA are also partially supported through an international research program, Immpact, funded by the Bill & Melinda Gates Foundation, the Department for International Development, the European Commission and USAID

Falciparum malaria in young children of rural Burkina Faso: comparison of survey data in 1999 with 2009

<p>Abstract</p> <p>Background</p> <p>Roll Back Malaria (RBM) interventions such as insecticide-treated mosquito nets (ITN) and artemisinin-based combination therapy (ACT) have become implemented with different velocities in the endemic countries of sub-Saharan Africa (SSA) in recent years. There is conflicting evidence on how much can be achieved under real life conditions with the current interventions in the highly endemic savannah areas of SSA.</p> <p>Methods</p> <p>The study took place in a rural area of north-western Burkina Faso, which was defined as holoendemic in 1999. Clinical and parasitological data were compared in two cohorts of young children of the same age range from eight villages. Surveys took place in June and December of the year 1999 and 2009 respectively.</p> <p>Results</p> <p>Prevalence of mosquito net use increased from 22% in 1999 to 73% in 2009, with the majority of nets being ITNs in 2009. In 2009, <it>P. falciparum </it>prevalence was significantly lower compared to 1999 (overall reduction of 22.8%).</p> <p>Conclusions</p> <p>The reduction in malaria prevalence in young children observed between 1999 and 2009 in a rural and formerly malaria holoendemic area of Burkina Faso is likely attributable to the increase in ITN availability and utilization over time.</p

A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem.

BACKGROUND: Although in developing countries the burden of morbidity and mortality due to infectious diseases has often overshadowed that due to chronic non-communicable diseases (NCDs), there is evidence now of a shift of attention to NCDs. DISCUSSION: Decreasing the chronic NCD burden requires a two-pronged approach: implementation of the multisectoral policies aimed at decreasing population-level risks for NCDs, and effective and affordable delivery of primary care interventions for patients with chronic NCDs. The primary care response to common NCDs is often unstructured and inadequate. We therefore propose a programmatic, standardized approach to the delivery of primary care interventions for patients with NCDs, with a focus on hypertension, diabetes mellitus, chronic airflow obstruction, and obesity. The benefits of this approach will extend to patients with related conditions, e.g. those with chronic kidney disease caused by hypertension or diabetes. This framework for a "public health approach" is informed by experience of scaling up interventions for chronic infectious diseases (tuberculosis and HIV). The lessons learned from progress in rolling out these interventions include the importance of gaining political commitment, developing a robust strategy, delivering standardised interventions, and ensuring rigorous monitoring and evaluation of progress towards defined targets. The goal of the framework is to reduce the burden of morbidity, disability and premature mortality related to NCDs through a primary care strategy which has three elements: 1) identify and address modifiable risk factors, 2) screen for common NCDs and 3) and diagnose, treat and follow-up patients with common NCDs using standard protocols. The proposed framework for NCDs borrows the same elements as those developed for tuberculosis control, comprising a goal, strategy and targets for NCD control, a package of interventions for quality care, key operations for national implementation of these interventions (political commitment, case-finding among people attending primary care services, standardised diagnostic and treatment protocols, regular drug supply, and systematic monitoring and evaluation), and indicators to measure progress towards increasing the impact of primary care interventions on chronic NCDs. The framework needs evaluation, then adaptation in different settings. SUMMARY: A framework for a programmatic "public health approach" has the potential to improve on the current unstructured approach to primary care of people with chronic NCDs. Research to establish the cost, value and feasibility of implementing the framework will pave the way for international support to extend the benefit of this approach to the millions of people worldwide with chronic NCDs