Understanding the Early Stages of Development of A Global Health Partnership

Maternal and child undernutrition contributes to more than one-third of child deaths. Global Health Partnerships (GHP) have emerged as a response to undernutrition and other pressing health problems. GHPs promote joint decision-making among donors, multilateral agencies, and country partners. Despite their positive impact on health problems, GHPs have generated unintended negative effects on country partners. This study aimed to understand the factors, strategies, and processes conducive to the establishment of an effective GHP in the context of a cooperative regional effort to reduce undernutrition and improve maternal and child health in eight countries in Latin America, Regional Health Initiative (RHI). The study used participant observation, document review, and semi-structured interviews to examine the planning and implementation of RHI overall and particularly in two of the eight countries. Deductive analysis was conducted using predetermined themes from the policy science framework. We also conducted inductive analysis that allowed for the identification of emergent themes. RHI partners had different, and in some instances, diverging perspectives. The lack of alignment of perspectives caused unintended consequences to the implementation of RHI in two countries such as the establishment of unrealistic aims for the country action plans, tension during the formulation of the action plans, and disagreements among partners that led to unexpected changes to the country action plans. We identified three factors that influenced this lack of alignment: 1) challenges in knowledge management, 2) non-inclusive governance structure, and 3) limited time for planning. Formulation of country action plans is often a contentious process. The successful formulation of an action plan occurs when the process pursues goals of feasibility, alignment, and ownership. Although RHI promoted feasibility, ownership, and alignment, the country context was a key determinant of the attainment of these goals. Lack of national health plans and aims, weak leadership of the Ministry of Health, and an upcoming political transition were factors that prevented reaching these three goals. These findings bring attention to the process of development of GHPs. The establishment of mechanisms to build trust and promote frequent communication among partners can lead to the early identification and alignment of perspectives. Furthermore, sociopolitical factors of country partners influence GHPs and should be taken into consideration during their planning and implementation. By recognizing that a complex context can delay or impede the attainment of goals during the formulation of country action plans, GHPs can be responsive to the country-specific challenges, devise appropriate procedures to address them, and adapt expectations to the context

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Effect of Added Sugar on the Consumption of A Lipid-Based Nutrient Supplement Among 7–24-Month-Old Children

Small-quantity lipid-based nutrient supplements (SQ-LNS) could help prevent malnutrition. Our primary objective was to examine the acceptability and consumption of sweetened and unsweetened versions of SQ-LNS before and after 14-days of repeated exposure. A total of 78 mother-infant dyads recruited from health centers in Morelos, Mexico, were randomized to two groups of SQ-LNS (sweetened, LNS-S; unsweetened, LNS-U). During the study, infants were fed SQ-LNS (20 g) mixed with 30 g of complementary food of the caregiver’s choice. The amount of supplement-food mixture consumed was measured before, during and after a 14-day home exposure period. We defined acceptability as consumption of at least 50% of the offered food mixture. At initial exposure, LNS-U consumption was on average 44.0% (95% CI: 31.4, 58.5) and LNS-S 34.8% (25.3, 44.0); at final exposure, LNS-U and LNS-S consumption were 38.5% (27.8, 54.0) and 31.5% (21.6, 43.0). The average change in consumption did not differ between the groups (2.2 p.p. (−17.2, 24.4)). We conclude that the acceptability of sweetened and unsweetened SQ-LNS was low in this study population. Since consumption did not differ between supplement versions, we encourage the use of the unsweetened version given the potential effects that added sugar may have on weight gain especially in regions facing the double burden of malnutrition