2 research outputs found
Does the effect of periodic presumptive treatment with oral metronidazole and fluconazole on the incidence of vaginal infections and Lactobacillus colonization depend on baseline vaginal infection status?
Thesis (Master's)--University of Washington, 2013Background: Vaginal infections are common, and associated with adverse health outcomes. Periodic presumptive treatment (PPT) is an effective intervention for preventing these infections. The PPT effect could be improved if it were restricted to women most likely to benefit from it. Methods: We conducted a subgroup analysis of data from a PPT trial in Mombasa, Kenya using Andersen-Gill proportional hazards models with robust variance estimates to assess the effect of the intervention among participants with a baseline vaginal infection versus those without. Results: Of 302 women eligible for analysis, 137 (45%) had one or more vaginal infections at baseline, while 165 (55%) had none. In the subgroup with a baseline vaginal infection, the intervention reduced the risk of incident BV [hazard ratio (HR)=0.55, 95% confidence interval (CI): 0.41-0.76] and increased vaginal colonization with any Lactobacillus species (HR=1.61, 95% CI: 1.01-2.56) as well as H2O2-producing Lactobacillus species (HR=1.85, 95% CI: 1.00-3.45) compared to placebo. In the subgroup without a baseline vaginal infection, the effect of the intervention to reduce incident BV (HR=0.71, 95% CI: 0.47-1.09) and increase vaginal colonization with any Lactobacillus species (HR=1.32, 95% CI: 0.85-2.04) as well as H2O2-producing Lactobacillus species (HR=1.48, 95% CI: 0.73-3.01), was less strong and not statistically significant. Conclusion: In this PPT trial, the effect of the intervention was driven primarily by participants with a baseline vaginal infection. Restricting PPT to women who are most likely to benefit from it may improve the effect of the intervention. "Background" "Methods" "Results" "Conclusion" "Lactobacillus
'Our voices matter' : the role of individuals, families and communities in creating and driving demand for maternal health services
Popularizing Summary
This doctoral research was conducted between 2013 - 2015 in Kwale county, Kenya so as to
understand the cultural beliefs, traditions and practices of the Digo, the main community
living there, and how these could influence whether or not they take up and use interventions
aimed at improving the health of women. It was aimed at describing how the community is
structured in terms of the place of women in society, who makes decisions around the health
of women, the role of religion in determining the health of women and how all these may
have changed over time. This was meant to describe the context under which maternal health
programs in this setting were being implemented. The main approach to this research
involved participating in their day-to-day activities so as to better understand their way of life
and how this had changed over time as well as conducting interviews and having group
discussions with various community members, community ‘gatekeepers’, local
administrators, key opinion leaders, local health providers as well as other local stakeholders.
The study also designed and tested an intervention that actively involved the community in
making decisions to improve the health and well-being of women. This was implemented
through structured community meetings that sought to create awareness of the benefits of
using family planning methods and giving birth under the supervision of a skilled health
provider. The meetings allowed community members to identify local issues that promoted
or discouraged use of these services then create a specific plan of action to encourage more
women in the community to use these services. They also tracked the implementation and
outcome of these plans of action.
To determine whether this intervention had improved the use of family planning methods
and increased the number of women giving birth under the supervision of skilled providers,
we compared the number of women who had used these services before and after our
intervention. We also interviewed individual women in their households regarding their
current use of family planning methods as well as their most recent place of giving birth. This
assessment showed a significant increase in the use of family planning methods and the
number of health facility births. Findings from this study also showed that among the Digo,
specific standards related to their predominant Islamic religion as well as widely held beliefs
about the place of men versus women in the society, were an important influence on whether
women ultimately used family planning methods and/or delivered under the supervision of a
skilled health provider. Specifically, we found that a prominent mother-figure in the
community played an important role in deciding whether or not women gave birth in a health
facility or used family planning methods.
The findings from this doctoral research highlight the importance of implementing public
health programs by responding to the unique way of life of targeted communities. They
illustrate the success that such programs could achieve when they actively involve individuals,
families and communities targeted by their interventions. These findings are important for
policy makers, public health practitioners and researchers in similar setting to enable them to
understand the context within which they are working and to actively involve individuals,
families and communities in order to have effective outcomes. Most importantly, the findings
underscore the need to be sensitive to the local way of life and address unique factors that
either prevent or promote uptake of public health services so as to remain relevant and
sustainable over time