Contraceptive Discontinuation and Unintended Pregnancy: An Imperfect Relationship

Contraceptive discontinuation is a common event. We hypothesize that a significant proportion of contraceptive discontinuations are associated with low motivation to avoid pregnancy; this will be reflected in a significant proportion of pregnancies following discontinuation being reported as intended

Prevalence and Correlates of Physical Spousal Violence Against Women in Slum and Nonslum Areas of Urban Bangladesh

This study explored the prevalence and correlates of past-year physical violence against women in slum and non-slum areas of urban Bangladesh. We used multivariate logistic regression to analyze data from the 2006 Urban Health Survey, a population-based survey of 9122 currently married women aged 15–49 selected using a multi-stage cluster sampling design. The prevalence of reported past-year physical spousal violence was 31%. Prevalence of past-year physical spousal violence was higher in slums (35%) than in non-slums (20%). Slapping/arm-twisting and pushing/shaking/throwing something at the women were the most commonly reported acts of physical abuse. Multivariate analysis showed that the risk of physical spousal abuse was lower among older women, women with post-primary education, and those belonging to rich households and women whose husband considered their opinion in decision-making. Women were at higher risk of abuse if they had many children, believed that married woman should work if the husband is not making enough money, and approved wife beating norms. This study serves to confirm the commonness of physical spousal abuse in urban Bangladesh demonstrating the seriousness of this multifaceted phenomenon as a social and public health issue. The present findings suggest the need for comprehensive prevention and intervention strategies that capitalize on the interplay of individual and sociocultural factors that cause physical spousal violence. Our study adds to a growing literature documenting domestic violence against women in urban areas of developing south Asian nations

Targeting HIV Interventions for Adolescent Girls and Young Women in Southern Africa: Use of the PLACE Methodology in Hwange District, Zimbabwe

This paper addresses the issue of how to target interventions to girls 15-19 and young women 20-24 in a resource poor setting of Hwange District, Zimbabwe. The Priorities for Local AIDS Control efforts (PLACE) methodology was used to understand where these young people socialize and also to understand whether age disparate relationships were a common occurrence. Findings indicated prevention efforts for those 15-19 would need to focus on “everyday” sites as these are the places where the majority of girls socialized. However the girls 15-19 with the riskiest sexual behaviors were found at venues affiliated with alcohol. Prevention efforts for those 20-24 would also need to largely focus on venues affiliated with alcohol. Women at such sites generally reported more risky behaviors than women in other types of venues. Reporting of a partner five or more years older was common across age groups and across venues. Tackling HIV in Zimbabwe will take a multifaceted approach targeted towards the places girls 15-19 and young women 20-24 are meeting new partners

Evidence of high-risk sexual behaviors among injection drug users in the Kenya PLACE study

Injection drug users (IDUs) in resource poor settings are at high risk for HIV transmission through unsafe needle-sharing and sexual practices. We report on the injecting and sexual behavior of a sample of IDUs from Malindi, Kenya

A Venue-Based Approach to Reaching MSM, IDUs and the General Population with VCT: A Three Study Site in Kenya

A venue-based HIV prevention study which included Voluntary Counseling and Testing (VCT) was conducted in three diverse areas of Kenya— Malindi, Nanyuki and Rachounyo. Aims of the study were to: 1) assess the acceptability of VCT for the general population, men who have sex with men (MSM), and injecting drug users (IDUs) within the context of a venue-based approach; 2) determine if there were differences between those agreeing and not agreeing to testing; and 3) study factors associated with being HIV positive. Approximately 98% of IDUs and 97% of MSM agreed to VCT, providing evidence that populations with little access to services and whose behaviors are stigmatized and often considered illegal in their countries can be reached with needed HIV prevention services. Acceptability of VCT in the general population ranged from 60% in Malindi to 48% in Nanyuki. There were a few significant differences between those accepting and declining testing. Notably in Rachuonyo and Malindi those reporting multiple partners were more likely to accept testing. There was also evidence that riskier sexual behavior was associated with being HIV positive for both men in Rachounyo and women in Malindi. Overall HIV prevalence was higher among the individuals in this study compared to individuals sampled in the 2008–2009 Kenya Demographic and Health Survey, indicating the method is an appropriate means to reach the highest risk individuals including stigmatized populations

Reducing the burden of diarrhea among children under five years old: lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria

Background: In Nigeria, diarrhea remains one of the leading causes of death among children under five years old. Oral Rehydration Therapy (ORT) corners were introduced to health facilities in Bauchi and Sokoto states to serve as points of treatment for sick children and equip caregivers with necessary skills in case management of diarrhea and diarrhea prevention. Objectives: The operations research study examined the effect of facility-based ORT corners on caregivers\u2019 knowledge and skills in management of simple and moderate diarrhea at home, as well as caregivers\u2019 and service providers\u2019 perceived facilitators and barriers to utilization and delivering of ORT corner services. It also examined whether ORT activities were conducted according to the established protocols. Methods: This quantitative study relied on multiple sources of information to provide a complete picture of the current status of ORT corner services, namely surveys with ORT corner providers (N = 21), health facility providers (N = 23) and caregivers (N = 229), as well as a review of service statistics and health facility observations. Frequency distribution and binary analysis were conducted. Results: The study revealed that ORT corner users were more knowledgeable in diarrhea prevention and management and demonstrated better skills for managing diarrhea at home than ORT corner non-users. However, the percentage of knowledgeable ORT users is not optimal, and providers need to continue to work toward improving such knowledge. ORT corner providers identified a lack of supplies as the major barrier for providing services. Furthermore, the study revealed a lack of information, education and communication materials, supportive supervision, and protocols and guidelines for delivering ORT corner services, as well as inadequate documentation of services provided at ORT corners. Recommendations: Recommendations for ORT corners program planners and implementers include ensuring all ORT corners have oral rehydration salt (ORS) packages and salt, sugar, and zinc tablets in stock, a secured commodity supply chain to avoid stockouts, and adequate policies and procedures in place

Mortality overview in Zimbabwe: a Chitungwiza case study

A case study of mortality rates in Zimbabwe using the case of the dormitory town of Chitungwiza.Mortality is an important component of population change. Its decline in the Third World during the second half of the present century has played a significant role in accelerating the rate of population growth. Although the fertility level of a country is expected to be a more decisive factor in determining future population growth rates, mortality levels are considered to be sensitive indicators of the level of development of societies and communities. Infant and child mortality rates are important indicators of health in countries lacking information on adult mortality conditions (the majority of developing countries). These rates function as important indicators of mortality of all age groups (Preston, 1985). Beyond their usefulness as health indicators, infant and child mortality rates are an essential part of demographic accounting. The birth rates and growth rates of a population cannot be known with any certainty without accurate infant and child mortality rates

A case study of community-based distribution and use of Misoprostol and Chlorhexidine in Sokoto State, Nigeria

The United States Agency for International Development/Targeted States High Impact Project supported Sokoto State, Nigeria government in the development of a community-based intervention aimed at preventing post-partum haemorrhage (PPH) and cord infection among women and children, respectively. This paper describes the innovative intervention within the Nigeria health delivery system. It then explains the case study approach to assessing this intervention and summarises findings. Ultimately, the intervention was received well in communities and both drugs were added to the procurement list of all health facilities providing maternity services in the State. Key factors leading to such success include early advocacy efforts at the state-level, broad stakeholder engagement in designing the distribution system, early community engagement about the value of the drugs and concerted efforts to monitor and ensure availability of the drugs. Implementation challenges occurred in some areas, including shortage of community-based health volunteers (CBHVs) and drug keepers, and socio-cultural barriers. To maximise and sustain the effectiveness of such interventions, state government needs to ensure constant drug supply and adequate human resources at the community level, enhance counselling and mobilisation efforts, establish effective quality improvement strategies and implement a strong M&E system

Interventions for Maintenance of Essential Health Service Delivery during the COVID-19 Response in Uganda, between March 2020 and April 2021

Introduction: The COVID-19 pandemic overwhelmed health systems globally and affected the delivery of health services. We conducted a study in Uganda to describe the interventions adopted to maintain the delivery of other health services. Methods: We reviewed documents and interviewed 21 key informants. Thematic analysis was conducted to identify themes using the World Health Organization health system building blocks as a guiding framework. Results: Governance strategies included the establishment of coordination committees and the development and dissemination of guidelines. Infrastructure and commodity strategies included the review of drug supply plans and allowing emergency orders. Workforce strategies included the provision of infection prevention and control equipment, recruitment and provision of incentives. Service delivery modifications included the designation of facilities for COVID-19 management, patient self-management, dispensing drugs for longer periods and the leveraging community patient networks to distribute medicines. However, multi-month drug dispensing led to drug stock-outs while community drug distribution was associated with stigma. Conclusions: Health service maintenance during emergencies requires coordination to harness existing health system investments. The essential services continuity committee coordinated efforts to maintain services and should remain a critical element of emergency response. Self-management and leveraging patient networks should address stigma to support service continuity in similar settings and strengthen service delivery beyond the pandemic