Examining the association between self-reported condom use and sexually transmitted infections

Two analyses were performed using data from an 18-month study of a condom promotion intervention among 1000 female sex workers (FSW) in two cities in Madagascar. The first analysis explored whether participating in such a study and being exposed to such an intervention over time would change the strength of the association between self-reported condom use and incident sexually transmitted infections (STI). The analysis found no evidence of a change in the association over time. In addition, there was no indication of a dose-response relationship between the number of reported unprotected sex acts and incidence of STI. The second analysis tested the risk of STI associated with self-reported condom use by partner type. Over the 18 months of the study, participants reported greatly increased rates of condom use with clients, but continued low condom use with personal partners. Participants who reported less than 100% condom use with personal partners, but 100% condom use with clients had no increased odds of STI as compared to those who reported 100% condom use with both partner types (odds ratio (OR) 0.9, 95% confidence interval (CI) 0.5, 1.6). Conversely, participants who reported inconsistent condom use with clients, but consistent condom use with their personal partners had an 8.3 times higher odds of STI (95% CI 0.5, 138.0) as compared to consistent condom users with both partner types. We conclude that asking study participants to report the actual number of sex acts and the number of those sex acts that were protected by condoms may result in falsely precise estimates of their exposure to risky sex acts. The results indicating that unprotected sex with personal partners does not contribute to risk of STI are contrary to indications from other recent studies in West Africa about the infection status of personal partners of FSW. The relationship should be further explored before programs change the message that FSW should use condoms with all partners

Balancing workload, motivation and job satisfaction in Rwanda: assessing the effect of adding family planning service provision to community health worker duties

BackgroundTask shifting from higher cadre providers to CHWs has been widely adopted to address healthcare provider shortages, but the addition of any service can potentially add to an already considerable workload for CHWs. Objective measures of workload alone, such as work-related time and travel may not reflect howCHWs actually perceive and react to their circumstances. This study combined perception and objectivemeasures of workload to examine their effect on quality of services, worker performance, and job and clientsatisfaction.MethodsThree hundred eighty-three CHWs from control and intervention districts, where the intervention group was trained to provide contraceptive resupply, completed diaries of work-related activities for one month. Interviews were also conducted with a subset of CHWs and their clients.ResultsCHW diaries did not reveal significant differences between intervention and control groups in time spent on service provision or travel. Over 90% of CHWs reported workload manageability, job satisfaction, and motivation to perform their jobs. Clients were highly satisfied with CHW services and most stated preference for future services from CHWs.ConclusionThe study demonstrated that adding resupply of hormonal contraceptives to CHWs’ tasks would not place undue burden on them. Accordingly, the initiative was scaled upin all 30 districts in the country

Provider and client perspectives on maternity care in Namibia: results from two cross-sectional studies

Abstract Background Disrespectful and abusive maternity care is a complex phenomenon. In Namibia, HIV and high maternal mortality ratios make it vital to understand factors affecting maternity care quality. We report on two studies commissioned by Namibia’s Ministry of Health and Social Services. A health worker study examined cultural and structural factors that influence maternity care workers’ attitudes and practices, and a maternal and neonatal mortality study explored community perceptions about maternity care. Methods The health worker study involved medical officers, matrons, and registered or enrolled nurses working in Namibia’s 35 district and referral hospitals. The study included a survey (N = 281) and 19 focus group discussions. The community study conducted 12 focus groups in five southern regions with recently delivered mothers and relatives. Results Most participants in the health worker study were experienced maternity care nurses. One-third (31%) of survey respondents reported witnessing or knowing of client mistreatment at their hospital, about half (49%) agreed that “sometimes you have to yell at a woman in labor,” and a third (30%) agreed that pinching or slapping a laboring woman can make her push harder. Nurses were much more likely to agree with these statements than medical officers. Health workers’ commitment to babies’ welfare and stressful workloads were the two primary reasons cited to justify “harsh” behaviors. Respondents who were dissatisfied with their workload were twice as likely to approve of pinching or slapping. Half of the nurses surveyed (versus 14% of medical officers) reported providing care above or beneath their scope of work. The community focus group study identified 14 negative practices affecting clients’ maternity care experiences, including both systemic and health-worker-related practices. Conclusions Namibia’s public sector hospital maternity units confront health workers and clients with structural and cultural impediments to quality care. Negative interactions between health workers and laboring women were reported as common, despite high health worker commitment to babies’ welfare. Key recommendations include multicomponent interventions that address heavy workloads and other structural factors, educate communities and the media about maternity care and health workers’ roles, incorporate client-centered care into preservice education, and ensure ongoing health worker mentoring and supervision

Late-time Light Curves of Type II Supernovae: Physical Properties of SNe and Their Environment

We present BVRIJHK band photometry of 6 core-collapse supernovae, SNe 1999bw, 2002hh, 2003gd, 2004et, 2005cs, and 2006bc measured at late epochs (>2 yrs) based on Hubble Space Telescope (HST), Gemini north, and WIYN telescopes. We also show the JHK lightcurves of a supernova impostor SN 2008S up to day 575. Of our 43 HST observations in total, 36 observations are successful in detecting the light from the SNe alone and measuring magnitudes of all the targets. HST observations show a resolved scattered light echo around SN 2003gd at day 1520 and around SN 2002hh at day 1717. Our Gemini and WIYN observations detected SNe 2002hh and 2004et, as well. Combining our data with previously published data, we show VRIJHK-band lightcurves and estimate decline magnitude rates at each band in 4 different phases. Our prior work on these lightcurves and other data indicate that dust is forming in our targets from day ~300-400, supporting SN dust formation theory. In this paper we focus on other physical properties derived from the late time light curves. We estimate 56Ni masses for our targets (0.5-14 x 10^{-2} Msun) from the bolometric lightcurve of each for days ~150-300 using SN 1987A as a standard (7.5 x 10^{-2} Msun). The flattening or sometimes increasing fluxes in the late time light curves of SNe 2002hh, 2003gd, 2004et and 2006bc indicate the presence of light echos. We estimate the circumstellar hydrogen density of the material causing the light echo and find that SN 2002hh is surrounded by relatively dense materials (n(H) >400 cm^{-3}) and SNe 2003gd and 2004et have densities more typical of the interstellar medium (~1 cm^{-3}). The 56Ni mass appears well correlated with progenitor mass with a slope of 0.31 x 10^{-2}, supporting the previous work by Maeda et al. (2010), who focus on more massive Type II SNe. The dust mass does not appear to be correlated with progenitor mass.Comment: We corrected the 56Ni mass of SN2005cs and Figures 8 (a) and 8 (c

Diet influences mate choice selectivity in adult female wolf spiders

Most studies of female choice have assumed that mating preferences are shared within a population or species. However, variation both within and among females exists in natural populations, and foraging history is among the many ways in which females may vary. Here, we used diet manipulations in an effort to understand how foraging history influences female mate choice. Immature Schizocosa wolf spiders collected from a mixed population of brush-legged and non-ornamented males were reared in the laboratory on two diets that varied in both quality and quantity (low/high diet). For low- and high-diet individuals, we recorded data on rates of development, adult size and adult mate choice. Consistent with previous work, we found that high-diet spiders matured more quickly and were significantly larger as adults than low-diet spiders. Males also matured earlier than females. Body condition varied with diet treatment and sex. High-diet individuals and females were both characterized by better body condition indexes. In addition, high-diet brush-legged males had larger brushes than low-diet brush-legged males. Upon maturation, females were paired simultaneously with a low- and a high-diet male of the same form (brush-legged or non-ornamented) in a mate choice trial. While no obvious differences were observed in courtship and/or mating effort between males, female mate choice varied with the female’s diet treatment. High-diet females mated more frequently with high-diet males than with low-diet males, whereas low-diet females showed no selectivity

Getting to 70%: Barriers to modern contraceptive use for women in Rwanda

AbstractObjectiveTo identify reasons for non-use of modern family planning in Rwanda, to examine specific barriers to contraception, and to explore psychosocial factors influencing modern contraceptive use.MethodsIn total, 637 in-union, parous, and non-pregnant women aged 21–49years participated in a cross-sectional community-based survey in 5 districts. In-depth interviews (IDIs) were conducted with 54 women and 27 male partners. Multivariate logistic regression examined correlates of current non-use. IDI transcripts were analyzed independently and compared thematically with survey findings.ResultsOverall, 50% of survey respondents were using a modern method. Fertility- and partner-related variables were key correlates of non-use. The most commonly reported reasons for non-use were related to perceived fecundity. Men were mostly supportive of contraceptive use and had an important role in a woman’s decision to use contraception. Women’s IDIs revealed misperceptions about fertility leading to gaps in contraceptive coverage, particularly postpartum. Those IDIs also highlighted how provider practices, including screening for pregnancy through direct observation of menses, may hamper contraceptive use.ConclusionProgrammatic recommendations include increasing information efforts aimed at men; developing effective messages about postpartum risk of pregnancy and training providers on postpartum contraceptive eligibility and needs; and reinforcing use of alternative pregnancy-screening methods

Provider and client perspectives on maternity care in Namibia: results from two cross-sectional studies

Abstract Background Disrespectful and abusive maternity care is a complex phenomenon. In Namibia, HIV and high maternal mortality ratios make it vital to understand factors affecting maternity care quality. We report on two studies commissioned by Namibia’s Ministry of Health and Social Services. A health worker study examined cultural and structural factors that influence maternity care workers’ attitudes and practices, and a maternal and neonatal mortality study explored community perceptions about maternity care. Methods The health worker study involved medical officers, matrons, and registered or enrolled nurses working in Namibia’s 35 district and referral hospitals. The study included a survey (N = 281) and 19 focus group discussions. The community study conducted 12 focus groups in five southern regions with recently delivered mothers and relatives. Results Most participants in the health worker study were experienced maternity care nurses. One-third (31%) of survey respondents reported witnessing or knowing of client mistreatment at their hospital, about half (49%) agreed that “sometimes you have to yell at a woman in labor,” and a third (30%) agreed that pinching or slapping a laboring woman can make her push harder. Nurses were much more likely to agree with these statements than medical officers. Health workers’ commitment to babies’ welfare and stressful workloads were the two primary reasons cited to justify “harsh” behaviors. Respondents who were dissatisfied with their workload were twice as likely to approve of pinching or slapping. Half of the nurses surveyed (versus 14% of medical officers) reported providing care above or beneath their scope of work. The community focus group study identified 14 negative practices affecting clients’ maternity care experiences, including both systemic and health-worker-related practices. Conclusions Namibia’s public sector hospital maternity units confront health workers and clients with structural and cultural impediments to quality care. Negative interactions between health workers and laboring women were reported as common, despite high health worker commitment to babies’ welfare. Key recommendations include multicomponent interventions that address heavy workloads and other structural factors, educate communities and the media about maternity care and health workers’ roles, incorporate client-centered care into preservice education, and ensure ongoing health worker mentoring and supervision

Integrated mental health screening for obstetric fistula patients in Mali: From evidence to policy.

BackgroundObstetric fistula significantly impacts women's mental health and well-being. Routine screening for mental health in fistula repair programs can be a gateway to link patients to services, and can produce routine data to inform programmatic investments. This study observed the integration of a mental health screening program into an obstetric fistula repair program in Mali, with two specific objectives: 1) to describe the social and mental health well-being of women presenting with obstetric fistulas in Mali, and 2) to document the impact of the mental health screening pilot on policy change in Mali.MethodsSeven fistula repair campaigns were conducted between June 2016 and May 2017. All individuals presenting for fistula repair completed a mental health assessment at intake, including a depression screener (PHQ-9) and an assessment of psycho-social impacts of fistula. The depression screener was repeated three months following inpatient discharge. Findings were shared with stakeholders in Mali and impacts on policy were documented.ResultsOf 207 women who presented for fistula repair, 167 patients completed the mental health assessment at surgical intake, and 130 patients repeated the screener at 3-month follow-up. At intake, 36.5% of women had moderate or severe depression, decreasing to 16.9% at follow-up. The mean depression score differed significantly by timepoint (9.14 vs. 6.72, p ConclusionThe high prevalence of depression in Malian fistula patients underscores a need for more robust mental health support for patients after surgery. Data on mental health from routine screening informs community reintegration strategies for individual patients, elevates the overall quality of care of fistula repair programs by addressing patients' holistic health needs, and contributes to evidence-informed decision-making and data-driven policy change within the larger health system