Sexual onset and contraceptive use among adolescents from poor neighbourhoods in Managua, Nicaragua

Background and objectives: The prevalence of teenage pregnancies in Nicaragua is the highest in Latin-America. This study aimed to gain insight into factors which determine the sexual behaviours concerned. Methods: From July until August 2011, a door-to-door survey was conducted among adolescents living in randomly selected poor neighbourhoods of Managua. Logistic regression was used to analyse factors related to sexual onset and contraceptive use. Results: Data from 2803 adolescents were analysed. Of the 475 and 299 sexually active boys and girls, 43% and 54%, respectively, reported contraceptive use. Sexual onset was positively related to increasing age, male sex, alcohol consumption and not living with the parents. Catholic boys and boys never feeling peer pressure to have sexual intercourse were more likely to report consistent condom use. Having a partner and feeling comfortable talking about sexuality with the partner were associated with hormonal contraception. Conclusions: Our data identifi ed associates of adolescents ’sexual behaviour related to personal characteristics (sex and alcohol use), to the interaction with signifi cant others (parents, partners, peers) and to the environment (housing condition, religion). We interpreted those associates within the context of the rapidly changing society and the recently implemented health system reform in Nicaragua

The cost-effectiveness of a competitive voucher scheme to reduce sexually transmitted infections in high-risk groups in Nicaragua.

Current evidence suggests that sexually transmitted infection (STI) interventions can be an effective means of human immunodeficiency virus (HIV) prevention in populations at an early stage of the epidemic. However, evidence as to their cost-effectiveness when targeted at high-risk groups is lacking. This paper assesses the cost-effectiveness of a competitive voucher scheme in Managua, Nicaragua aimed at high-risk groups, who could redeem the vouchers in exchange for free STI testing and treatment, health education and condoms, compared with the status quo (no scheme). A provider perspective was adopted, defined as: the voucher agency and health care providers from the public, NGO and private sectors. The cost of the voucher scheme was estimated for a 1-year period (1999) from project accounts using the ingredients approach. Outcomes were monitored as part of ongoing project evaluation. Costs and outcomes in the absence of the scheme were modelled using project baseline data and reports, and relevant literature. The annual cost of providing comprehensive STI services through vouchers was US$62 495, compared with an estimated US$17 112 for regular service provision in the absence of the scheme. 4815 vouchers were distributed by the voucher scheme, 1543 patients were tested for STIs and 528 STIs were effectively cured in this period. In the absence of the scheme, only an estimated 85 cases would have been cured from 1396 consultations. The average cost of the voucher scheme per patient treated was US$41 and US$118 per STI effectively cured, compared with US$12 per patient treated and US$200 per STI cured in its absence. The incremental cost of curing an STI through the voucher scheme, compared with the status quo, was US$103. A voucher scheme offers an effective and efficient means of targeting and effectively curing STIs in high-risk groups, as well as encouraging quality care practices

Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: a retrospective analysis

Resumen Antecedentes La salud sexual y reproductiva de los adolescentes (SSR), como problemas de embarazos no planificados son complejos y multifactoriales, por lo que requieren múltiples intervenciones para su prevención. Evaluar el impacto de estas intervenciones es importante para asegurar la eficiencia, la eficacia y la rendición de cuentas para los donantes de proyectos y los miembros de la comunidad. En este estudio, proponemos la Gestión Basada en Resultados (o su sigla en inglés RBM) como un marco para la gestión de proyectos, utilizando el Community Embedded Reproductive Health Care for Adolescents (CERCA) como un caso de estudio para RBM. El Proyecto CERCA (2010-2014) puso a prueba las intervenciones para reducir el embarazo adolescente en tres países de América Latina, Bolivia, Ecuador y Nicaragua. Las actividades fueron diseñadas para mejorar los comportamientos adolescentes en SRH en cuatro aspectos: comunicación con padres, compañeros y pareja; acceso a la información sobre SSR; acceso a los servicios de SSR; y uso de anticonceptivos. Cuando el proyecto terminó, la evaluación de resultados mostró un impacto limitado sobre todo por la precisión en el monitoreo y pérdidas en el seguimiento de cohortes. Métodos Se revisó y analizó una serie de documentos CERCA y fuentes de datos relacionados. Las principales conclusiones de estos documentos se organizaron en el marco lógico de la Gestión Basada en Resultados (planificación, monitoreo y evaluación del impacto) para comprender cómo la metodología y el rendimiento de CERCA podrían haber obtenido mejores resultados. Resultados Se identificaron fortalezas y debilidades en los tres elementos del marco de RBM. En la Planificación, la propuesta Teoría del Cambio (ToC) difiere de la que se llevó a cabo en el paquete de intervención. Cada país implementó un paquete de intervención diferente sin supuestos articulados sobre cómo estas actividades de intervención producirían cambios. En el Monitoreo, la gestión del proyecto se basó principalmente en requisitos administrativos y financieros en lugar de supervisar la fidelidad y la calidad de las actividades de intervención. En la Evaluación de Impacto, la evaluación original del CERCA evaluó los efectos de la intervención entre los adolescentes, sin identificar los factores de éxito y fracaso relacionados con los resultados, la naturaleza de los resultados o el análisis de costo-efectividad de las intervenciones. Conclusiones Este análisis mostró que los proyectos multinacionales son complejos, implican riesgos en la ejecución y requieren una gestión del proyecto sólida. La Gestión Basada en Resultados puede ser una herramienta útil para garantizar un enfoque sistemático en las distintas fases de un proyecto bajo un contexto multi-país

Community embedded reproductive health interventions for adolescents in Latin America: development and evaluation of a complex multi-centre intervention

Background: Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and reproductive health information, services and counselling. To date, many adolescent health programmes have targeted a single determinant of sexual and reproductive health. However, recent evidence suggests that the complexity of sexual and reproductive health issues demands an equally multi-layered and comprehensive approach. Methods: This article describes the development, implementation and evaluation design of the community-embedded reproductive health care for adolescents (CERCA) study in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador) and Managua (Nicaragua). Project CERCA\u27s research methodology builds on existing methodological frameworks, namely: action research, community based participatory research and intervention-mapping.The interventions in each country address distinct target groups (adolescents, parents, local authorities and health providers) and seek improvement of the following sexual health behaviours: communication about sexuality, sexual and reproductive health information-seeking, access to sexual and reproductive health care and safe sexual relationships.In Managua, we implemented a randomised controlled study, and in Cochabamba and Cuenca we adopted a non-randomised controlled study to evaluate the effectiveness of Project CERCA interventions, in addition to a process evaluation. Discussion: This research will result in a methodological framework that will contribute to the improved design and implementation of future adolescent sexual and reproductive health interventions

Cloning and characterization of Arenicola marina peroxiredoxin6

Peroxiredoxins (PRDXs) are a superfamily of thiol-dependent selenium- and heme-free peroxidases found in all phyla. PRDXs are mechanistically divided into three subfamilies namely typical 2-Cys, atypical 2-Cys and 1-Cys PRDXs. To reduce peroxides, the N-terminal conserved peroxidatic Cys is first oxidized into sulfenic acid. According to the subfamily, this intermediate is reduced by forming a disulfide bond either with a resolving Cys of another monomeric entity (typical 2-Cys) or of the same molecule (atypical 2-Cys). Finally, in 1-Cys PRDXs, the sulfenic acid is reduced by a heterologous thiol-containing reductant. In the search of the homolog of human 1-Cys PRDX6 in Arenicola marina (Am), an annelid worm living in the sulfide-rich sediments of the intertidal zones, we have cloned and characterized a novel PRDX exhibiting high sequence homology with its mammalian counterpart. However, AmPRDX6, possesses five Cys among which one is at a homologous position to the resolving Cys of typical 2-Cys PRDXs. Here, we report that AmPRDX6 has a catalytic mechanism involving intermolecular disulfide bonds. The role of these Cys and their interactions have been investigated. We report also the kinetic characterization of the enzyme which shows that AmPRDX6 reacts with hydrogen peroxide and peroxynitrite with high rate constants. This fast reactivity can be, to some extent, explained by the low pKa of catalytic thiol. The recovery step was also examined using many potential physiological reductants but none were able to significantly reduce the enzyme. Moreover, to gain insights into the cellular functions of AmPRDX6, CHO cells were used as an in vitro model in which the enzyme was overexpressed. Cells were exposed to an acute oxidative stress but AmPRDX6 did not confer cytoprotection. In conclusion, this work shows that AmPRDX6 belongs to a transient group exhibiting sequence homologies with mammalian 1-Cys PRDX6 but must be mechanistically classified into typical 2-Cys PRDXs.(BIOL 3) -- UCL, 201

BMC Public Health

Background Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and reproductive health information, services and counselling. To date, many adolescent health programmes have targeted a single determinant of sexual and reproductive health. However, recent evidence suggests that the complexity of sexual and reproductive health issues demands an equally multi-layered and comprehensive approach. Methods This article describes the development, implementation and evaluation design of the community-embedded reproductive health care for adolescents (CERCA) study in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador) and Managua (Nicaragua). Project CERCA’s research methodology builds on existing methodological frameworks, namely: action research, community based participatory research and intervention-mapping. The interventions in each country address distinct target groups (adolescents, parents, local authorities and health providers) and seek improvement of the following sexual health behaviours: communication about sexuality, sexual and reproductive health information-seeking, access to sexual and reproductive health care and safe sexual relationships. In Managua, we implemented a randomised controlled study, and in Cochabamba and Cuenca we adopted a non-randomised controlled study to evaluate the effectiveness of Project CERCA interventions, in addition to a process evaluation. Discussion This research will result in a methodological framework that will contribute to the improved design and implementation of future adolescent sexual and reproductive health interventions.Cuencavolumen 13; número