Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement.

It is widely held that decisions whether or when to attend health facilities for childbirth are not only influenced by risk awareness and household wealth, but also by factors such as autonomy or a woman's ability to act upon her own preferences. How autonomy should be constructed and measured - namely, as an individual or cluster-level variable - has been less examined. We drew on household survey data from Zambia to study the effect of several autonomy dimensions (financial, relationship, freedom of movement, health care seeking and violence) on place of delivery for 3200 births across 203 rural clusters (villages). In multilevel logistic regression, two autonomy dimensions (relationship and health care seeking) were strongly associated with facility delivery when measured at the cluster level (OR 1.27 and 1.57, respectively), though not at the individual level. This suggests that power relations and gender norms at the community level may override an individual woman's autonomy, and cluster-level measurement may prove critical to understanding the interplay between autonomy and care seeking in this and similar contexts

Assessing Coverage of Targeted and Large-scale Fortification Programs: Development of a Fortification Assessment Coverage Tool (FACT)

Objectives: To develop and operationalize a survey tool that can be used by nutrition programmers to assess and classify coverage and consumption patterns in targeted (point-of-use) and large-scale (staple) fortification programs. Methods: We focused on developing a tool that is low-cost, and rapid for programs to implement, analyze, and assess coverage and barriers to coverage during the program cycle. Indicators were adapted from validated guidelines, and subject matter experts were consulted. We emphasize simple spatial survey (S3M) methods, which allow for fine scale geographical coverage maps and wide-area population-level estimates to be produced. The FACT tool can also be implemented using cluster survey methods. Results: A pilot FACT survey using S3M methods was first undertaken in three administrative districts in Ghana to refine the survey methods and instruments. Results were reported back to the program within two weeks of survey completion to provide a quick feedback loop to guide programming efforts. Subsequent implementation of the FACT tool has been applied to a statewide S3M survey in Rajasthan, India, and National cluster survey in Senegal. Conclusions: We have developed and operationalized a tool that can be applied to coverage assessments of targeted and large-scale fortification programs are planned. Additional work on the FACT tool will include refining the methods and instruments after running additional survey rounds, refining analysis and reporting tools, and disseminating in the public domain

From river blindness control to elimination: bridge over troubled water.

BACKGROUND: An estimated 25 million people are currently infected with onchocerciasis (a parasitic infection caused by the filarial nematode Onchocerca volvulus and transmitted by Simulium vectors), and 99% of these are in sub-Saharan Africa. The African Programme for Onchocerciasis Control closed in December 2015 and the World Health Organization has established a new structure, the Expanded Special Project for the Elimination of Neglected Tropical Diseases for the coordination of technical support for activities focused on five neglected tropical diseases in Africa, including onchocerciasis elimination. AIMS: In this paper we argue that despite the delineation of a reasonably well-defined elimination strategy, its implementation will present particular difficulties in practice. We aim to highlight these in an attempt to ensure that they are well understood and that effective plans can be laid to solve them by the countries concerned and their international partners. CONCLUSIONS: A specific concern is the burden of disease caused by onchocerciasis-associated epilepsy in hyperendemic zones situated in countries experiencing difficulties in strengthening their onchocerciasis control programmes. These difficulties should be identified and programmes supported during the transition from morbidity control to interruption of transmission and elimination

Household Coverage of Fortified Staple Food Commodities in Rajasthan, India

<div><p>A spatially representative statewide survey was conducted in Rajasthan, India to assess household coverage of atta wheat flour, edible oil, and salt. An even distribution of primary sampling units were selected based on their proximity to centroids on a hexagonal grid laid over the survey area. A sample of <i>n</i> = 18 households from each of <i>m =</i> 252 primary sampling units PSUs was taken. Demographic data on all members of these households were collected, and a broader dataset was collected about a single caregiver and a child in the first 2 years of life. Data were collected on demographic and socioeconomic status; education; housing conditions; recent infant and child mortality; water, sanitation, and hygiene practices; food security; child health; infant and young child feeding practices; maternal dietary diversity; coverage of fortified staples; and maternal and child anthropometry. Data were collected from 4,627 households and the same number of caregiver/child pairs. Atta wheat flour was widely consumed across the state (83%); however, only about 7% of the atta wheat flour was classified as fortifiable, and only about 6% was actually fortified (mostly inadequately). For oil, almost 90% of edible oil consumed by households in the survey was classified as fortifiable, but only about 24% was fortified. For salt, coverage was high, with almost 85% of households using fortified salt and 66% of households using adequately fortified salt. Iodized salt coverage was also high; however, rural and poor population groups were less likely to be reached by the intervention. Voluntary fortification of atta wheat flour and edible oil lacked sufficient industry consolidation to cover significant portions of the population. It is crucial that appropriate delivery channels are utilized to effectively deliver essential micronutrients to at-risk population groups. Government distribution systems are likely the best means to accomplish this goal.</p></div

Summary of Atta Wheat Flour and Salt Specimens Collected and Analyzed.

<p>Summary of Atta Wheat Flour and Salt Specimens Collected and Analyzed.</p

Spatial distribution of raw coverage for salt.

<p>Spatial distribution of raw coverage for salt.</p

Summary Statistics for Risk and Coverage for Each Food Vehicle.

<p>Summary Statistics for Risk and Coverage for Each Food Vehicle.</p

Spatial distribution of raw coverage for atta wheat flour.

<p>Spatial distribution of raw coverage for atta wheat flour.</p

Tanahashi model of coverage measures applied to fortification indicators.

<p>Tanahashi model of coverage measures applied to fortification indicators.</p

Activity Summary for the GAIN Rajasthan Fortification Program^a.

<p>Activity Summary for the GAIN Rajasthan Fortification Program<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0163176#t001fn001" target="_blank">^a</a>.</p