Strategies for recruitment and retention of teen mothers in a program to prevent repeat pregnancy

Background: We describe challenges to recruitment and retention of teen mothers in a study to prevent repeat teen pregnancies, and strategies used to overcome them. Methods: We documented recruitment efforts, the teens who were retained at each stage of the intervention and changes to strategies. Results: Challenges to recruitment and retention were related to lifestyles, immaturity, and competing demands, among others. Successful strategies included bus advertisements, early pairing of teens with mentors, using electronic media, convenient meeting times with a meal, providing child care, transportation vouchers and immediate incentives. Conclusions: This study highlights impediments to teen mother research recruitment and retention, and the value of emerging technologies and strong bonding relationships early in the intervention to maximize recruitment and retention

Strengthening Healthcare Capacity Through a Responsive, Country-Specific, Training Standard: The KITSO AIDS Training Program’s Sup-port of Botswana’s National Antiretroviral Therapy Rollout

In parallel with the rollout of Botswana’s national antiretroviral therapy (ART) program, the Botswana Ministry of Health established the KITSO AIDS Training Program by entering into long-term partnerships with the Botswana–Harvard AIDS Institute Partnership for HIV Research and Education and others to provide standardized, country-specific training in HIV/AIDS care. The KITSO training model has strengthened human capacity within Botswana’s health sector and been indispensable to successful ART rollout. Through core and advanced training courses and clinical mentoring, different cadres of health care workers have been trained to provide high-quality HIV/AIDS care at all ART sites in the country. Continuous and standardized clinical education will be crucial to sustain the present level of care and successfully address future treatment challenges

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

The role of industries in providing basic life-skills education to unskilled black employees in the Empangeni/Richards Bay industrial areas

Thesis (MPhil)--Stellenbosch University, 2001.ENGLISH ABSTRACT: Historically, the majority of South Africans were denied access to free, compulsory and general education (National Multi-Plan, 1997:1). This means that many citizens did not have access to that educational foundation necessary for further learning, quality employment opportunities or even full and active social and political participation. Various arguments throughout this study imply that the South African education system presented unequal educational opportunities for most of its people. In this case, Black Education failed to produce people with the necessary skills for our economy. To compensate these people, the opportunities for education should be created everywhere in schools, sports clubs, NGOs and more importantly, in workplaces because education is the key for survival. Due to the need for economic growth and the need for skilled workers, large numbers of adults should be provided with extensive adult education. In other words, industries should become educational centres where employees could be equipped with numeracy and literacy programmes which would improve production and basic life-skills necessary to meet the demands of the economy at large. The study sought to find out "what role the two industries play in providing basic life-skills education to unskilled Black employees in the Empangeni/Richards Bay industrial areas". This was an empirical survey involving the target population of unskilled Black employees and facilitators of the adult education programmes of the lllovo Sugar Milling and Spoornet industries. In this study two different types of questionnaires were designed and used to ascertain the respondents' disposition towards adult education programmes. In each industry one questionnaire was administered to the unskilled Black employees and another to the facilitators of adult education progarmnes. The research sample comprised of seven unskilled Black employees from lllovo, twentyfive unskilled Black employees from Spoomet, two facilitators from Illovo and another two facilitators from Spoornet industries. The data collected from the sample attempted to answer the following research questions: ./ What basic day-to- day life-skills are needed by unskilled Black employees in the industries? ./ How effective are these programmes to unskilled Black employees in the industries? ./ How accessible are these programmes to unskilled Black employees? These questions necessitated a literature study and an empirical survey as research tools. It has emerged from the study that adult education is seen as an agent for social change and instrument for social development. The study seeks to assess the extent to which these programmes: .:. Fulfil the day-to-day basic needs of unskilled Black employees, in for example, financial management or identifying and using sources of informatiom like directories and maps . •:. Fulfil the literacy and numeracy needs of unskilled Black employees, in for example, appending signatures, reading newspapers and bank forms . •:. Cultivate good habits in the workplace such as punctuality, time management, safety precautions and proper procedures. The findings reveal that adult education programmes in industries were valuable and useful to employees as they were able to transfer the skills acquired from the programme to the real world situation. These life-skills included counting money, writing names and letters, appending signatures, reading newspapers and safety precautions signs, understanding road signs and making telephone calls. The researcher concludes with a number of recommendations including the following: ~ Each industry should establish a building named a 'college' or 'centre' within its premises where adult education programmes will be presented. ~ Each industry should have its own policy documents regarding the provision of worker life-skills education. ~ All workers have a right to paid education and training leave. This means that skilled, semi-skilled and unskilled workers should be entitled to four or six weeks of paid leave per year for further education throughout their working life.AFRIKAANSE OPSOMMING: As gevolg van die historiese en politieke ontwikkeling in Suid-Afrika is die meerderheid van die bevolking toegang tot vrye, verpligte en algemene onderwys ontsê (National Multi- Plan, 1997: 1). Dit het tot gevolg gehad dat die meerderheid van die bevolking dus ook nie toegang gehad het tot verdere onderwys en gevolglik ook nie tot goeie werksgeleenthede en dus deelname aan die maatskaplike en politieke lewe ontneem is. In hierdie navorsing word minderwaardige onderwysgeleenthede wat aan die meeste swart mense gegee is uitgewys. Dit het tot gevolg gehad dat swart onderwys nie die opgeleide menslike hulpbronne kon lewer wat die ekonomie nodig gehad het nie. Ekonomiese groei is afhanklik van opgeleide menslike hulpbronne en om dit moontlik te maak behoort onderwysgeleenthede in groot getalle vir volwassenes geskep te word. Daarom behoort skoolfasiliteite, sportklubs, nie-regeringsorganisasies en die werkplek benut te word om onderwys aan die ongeletterde volwassene te gee. Dit impliseer dat nywerhede geleenthede vir geletterdheids- en syfervaardigheidsprogramme vir hulle werkers behoort te skep sodat hulle toegerus kan word met basiese lewensvaardighede en sodoende hulle lewenskwaliteit en produktiwiteit verhoog kan word. Met die navorsing is gepoog om vas te stel watter rol nywerhede in die Empangeni- /Richardsbaai-gebied speel in die verskaffing van onderwys in basiese lewensvaardighede aan hulle ongeskoolde swart werkers. Twee verskillende vraelyste en onderhoude is gebruik om data in te samel by 'n steekproef van die ongeskoolde swart werkers en die fasiliteerders van onderwysprogramme aan volwassenes by Illovo Suikermeule en Spoornet. Daar is gepoog om die respondente se houdings ten opsigte van onderwysprogramme aan volwassenes in dié twee nywerhede vas te stel. Die navorsinsteekproef het sewe ongeskoolde swart werkers en twee fasiliteerders van Illovo Suikermeule en vyf-en-twintig ongeskoolde swart werkers en twee fasiliteerders van Spoornet ingesluit. Met behulp van die ingesamelde data van die steekproef is gepoog om die volgende vrae te beantwoord: - Watter basiese lewensvaardighede benodig die ongeskoolde swart werkers in hierdie twee nywerhede? - Watter onderwysprogramme vir volwassenes is deur die twee nywerhede daargestelom in die onderwysbehoeftes in basiese lewensvaardighede van die ongeskoolde swart werkers te voorsien? Hoe toeganklik is hierdie programme vir die ongeskoolde swart werkers? Hoe effektief is die programme vir ongeskoolde swart werkers in die twee nywerhede? Om die vrae te probeer beantwoord was dit noodsaaklik om 'n literatuurstudie te doen, 'n vraelysopname te onderneem en onderhoude te voer. Die doelstellings met die navorsing was om te bepaal in watter mate die onderwysprogramme vir volwassenes in die twee nywerhede: voorsien in die daaglikse behoeftes van ongeskoolde swart werkers byvoorbeeld om hulle finansies te bestuur en om inligtingsbronne soos gidse en kaarte te identifiseer en te gebruik; voorsien in die geletterdheids - en syfervaardigheidsbehoeftes van ongeskoolde swart werkers soos die gebruik van 'n handtekening, die lees van koerante en die invul van bankvorms; lei tot 'n bewuswording en 'n besef van die belangrikheid van onderwys aan ongeskoolde swart werkers; ongeskoolde swart werkers voorberei om akademiese ondersteuning, soos byvoorbeeld hulpverlening met skoolwerk, aan hulle kinders te voorsien; 'n bewuswording skep van die maatskaplike, politieke, kulturele en ekonomiese verband waarin ongeskoolde swart werkers hulle bevind. Dit sluit die verskaffing van onderwys in basiese lewensvaardighede met betrekking tot vigs, gesinsbeplanning en kiesersopvoeding in; en die aankweek van goeie gewoontes in die werksituasie soos stiptelikheid. tydsbestuur, die toepassing van veiligheidsmaatreëls in die gebruik van korrekte procedures tot gevolg het. Die bevindinge van die navorsing dui daarop dat onderwysprogramme aan volwassenes in die nywerhede waardevol en nuttig vir die ongeskoolde swart werkers is aangesien dit hulle in staat stelom die vaardighede wat hulle aangeleer het na die werklike alledaagse lewenssituasie oor te dra. Hierdie vaardighede sluit onder andere in die tel van geld, die skryf van hulle name en briewe, die gebruik van 'n handtekening vir die ondertekening van dokumente, die lees van koerante en kennisgewings i.v.m. veiligheidsmaatreëls, die verstaan van padtekens en die maak van telefoonoproepe. Dit blyk ook uit die navorsing dat onderwysprogramme aan volwassenes as 'n werktuig van maatskaplike ontwikkeling beskou word. Die aanbevelings wat op grond van die bevindinge van die navorsing gemaak word, sluit onder andere die volgende in: Nywerhede wat groot getalle ongeskoolde swart werkers in diens het, behoort 'n beleid ten opsigte van onderwysprogramme in basiese lewensvaardighede aan werkers te hê. Elke nywerheid behoort fisiese fasiliteite vir die aanbieding van onderwysprogramme aan volwassenes op die perseel te hê. Hierdie fisiese fasiliteit kan 'n "kollege" of ,,s»entrum genoem wor d. Alle werkers behoort die reg te hê op vier tot ses weke betaalde onderwys-en opleidingsverlof per jaar

Factors associated with the uptake of cervical cancer screening among women in Portland, Jamaica

Background: Cervical cancer is the second most common cancer among women worldwide and is the leading cause of deaths in developing countries. Despite the strong evidence that cervical cancer screening results in decreased mortality from this disease, the uptake for cervical screening among Jamaican women remains low. Aims : This study was carried out to identify factors associated with Jamaican women′s decisions to screen for cervical cancer. Materials and Methods: Cross-sectional descriptive study of 403 women aged 19 years and older from Portland, Jamaica. An interviewer-administered questionnaire assessed the women′s cervical cancer screening history, as well as their knowledge, attitudes, and practices regarding the disease and screening. Results: Of the 403 women interviewed, 66% had a Papanicolaou (Pap) smear and only 16% had a Pap test within the past year. Significant predicators of uptake of screening were being married, age, parity, discussing cancer with health provider, perception of consequences of not having a Pap smear, and knowing a person with cervical cancer. Women who did not know where to go for a Pap smear were 85% less likely to have been screened (prevalence odds ratio (POR): 0.15, 95% confidence interval (CI): 0.04, 0.52). Conclusions: This study showed suboptimal uptake of cervical cancer screening among Jamaican women. Multipronged approaches are needed to address barriers to screening, as well as identify and support conditions that encourage women′s use of reproductive health services, thereby reducing incidence and mortality rates from cervical cancer

Factors associated with acute pesticide poisoning among farmers in Northwestern Jamaica

The safe production and marketing of food is a major step towards food security. However, many farmers put themselves at risk from pesticide poisoning during the production process. The unsafe use of pesticides is a major problem, especially in Caribbean Common Market (CARICOM) countries where the most persistent and hazardous pesticides are used by farmers with limited training. Excessive and improper use of pesticides is one of the major causes of chemical poisoning in the CARICOM area. In Jamaica, high levels of pesticide residues have been detected in surface water and aquatic life but the extent of acute pesticide poisoning among farmers has not been determined. We conducted a population survey using an interviewer-administered questionnaire among farmers in three parishes of northwestern Jamaica to determine the occurrence of pesticide poisoning and to identify factors associated with pesticide poisoning. Approximately 16% of the 359 farmers who participated reported incidents of pesticide poisoning within the last two years. Age 40-49 years (compared with 20-39 years), shorter distance from home to the farm, 20-29 years of farming experience (compared with ≤20 years), using hand-held sprayers and never wearing masks/respirator when handling pesticides were significantly associated with pesticide poisoning. Factors that were protective against pesticide poisoning included, always reading the instructions on the pesticide bag before use, using special tools for mixing and applying pesticides, and farm owned/run by a family. The majority (60%) of farmers who reported pesticide poisoning never sought medical attention for poisoning. Approximately one in six Jamaican farmers experienced symptoms of acute pesticide poisoning but the majority did not seek medical attention. The factors found to be associated with pesticide poisoning in this study indicate that implementation of specific intervention strategies and education of farmers can lead to safe handling and use of pesticides and reduction of acute pesticide poisoning among farmers

The Effects of Prolonged Water-Only Fasting and Refeeding on Markers of Cardiometabolic Risk

(1) Background: Cardiometabolic disease, including insulin resistance, hyperlipidemia, and hypertension, are major contributors to adverse health outcomes. Fasting has gained interest as a nonpharmacological therapeutic adjunct for these disorders. (2) Methods: We conducted a prospective, single-center study on the effects of prolonged water-only fasting followed by an exclusively whole-plant-food refeeding diet on accepted measures of cardiovascular risk and metabolic health. Participants were recruited from patients who had voluntarily elected to complete a water-only fast in order to improve their overall health according to an established protocol at an independent, residential medical center. Median fasting and refeed lengths were 17 and 8 days, respectively. The primary endpoint was to describe the mean glucose tolerance as indicated by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) scores at baseline, end-of-fast (EOF), and end-of-refeed (EOR) visits. Secondary endpoints were to describe the mean weight, body mass index (BMI), abdominal circumference (AC), systolic blood pressure (SBP), diastolic blood pressure (DBP), lipid panel, and high-sensitivity C-reactive protein (hsCRP) at the same time points. (3) Results: The study enrolled 48 overweight/obese non-diabetic participants, of which 26 completed the full study protocol. At the EOF visit, the median SBP, AC, low-density lipoprotein (LDL), and hsCRP were decreased and triglycerides (TG) and HOMA-IR scores were increased. Conclusion: Prolonged water-only fasting and whole-plant-food refeeding holds potential as a clinical therapy for cardiometabolic disease but increased TG and HOMA-IR values after refeeding necessitate further inquiry

PESTICIDE USE AND HUMAN HEALTH IN NORTHWESTERN JAMAICA

A number of studies have detected high levels of pesticide residues in surface water and aquatic life in Jamaica and acute pesticide poisoning is believed to be widespread there. Despite efforts by the Jamaican government to create awareness of the dangers of pesticides and adopt safe a pesticide disposal method, many farmers still display poor pesticide handling and disposal practices. The objectives of this study were to 1) describe pesticide use by farmers in northwestern Jamaica including inappropriate methods in pesticides handling and disposal, and 2) determine whether farmers’ perception of the mode of bodily entry of pesticides affects their method of disposal. Farmers in Westmoreland, St. James and Hanover were surveyed using an investigator-administered instrument. Although 96% of farmers had some form of formal education, 75% had received no training in the use of pesticides. Only about 15% thought that crop yields and quality could be maintained without the use of pesticides. Only 29% believed that pesticide use posed a health risk, while 91% thought that pesticide use was an environmental hazard. Less than 45% of farmers used safety gear (gloves, masks, goggles) in handling pesticides although 65% always used special clothing. A fair proportion of farmers burn, bury or dump unused pesticide or empty pesticide containers in the bushes. Farmers’ disposal methods were influenced by their perception of the ways that pesticides enter the human body. Thus, a large percentage of farmers in these parishes use pesticides inappropriately and are exposed to pesticides in handling. Disposal of unused pesticides and empty pesticide containers pollute the environment and most likely expose others. Measures should be taken to educate farmers, to provide protective gear at an affordable price, and to implement a clear and consistent method for collection of unused pesticide and empty pesticide containers