Household disaster preparedness: assessing the importance of relational and community social capital

Household preparedness can help save lives and curtail staggering losses from natural disasters around the world. Finding ways to promote preparedness has become urgent in developing countries, which bear an increasingly disproportionate share of losses. Social capital reflects the quality of human relationships and may provide a useful resource to encourage households to prepare before it is too late. This study examines the influence of social capital on three aspects of household disaster preparedness: awareness of protective measures, knowledge of evacuation procedures and familiarity with response agencies. Two theoretical approaches to social capital are considered at the household-level: 1) relational social capital reflects the resources embedded in personal networks and is defined by resource composition, resource diversity and kinship composition; and 2) community social capital refers to the features of social organization (e.g., networks, norms and social trust) that promote cooperation within a group. Government representatives, civil society organizations in charge of disaster preparedness and community and household characteristics are also posited to influence household preparedness. Key informant interviews and a 182-household survey in 6 villages in Dominica in the Caribbean were used to assess the influence of relational and community social capital for locally-relevant measures of the three aspects of household preparedness. Results were analyzed for each outcome using logistic regression. The study.s key findings support that social capital enhances household preparedness and that this influence is moderate to strong relative to other factors. The effects of relational and community social capital, however, are distinct and furthermore vary across aspects of preparedness. Moreover, only resource diversity and to some extent kinship composition prove valuable characteristics of social networks. Diverse and kin-centered networks are valuable for awareness of protective measures. Networks with more diversity further enhance knowledge of evacuation procedures. Community social capital, on the other hand, improves familiarity with response agencies. In addition to emphasizing the importance of relationships among people for disaster preparedness, this study provides much needed empirical evidence contrasting two widely-used approaches to social capital. Relational and community social capital correspond to different types of human interactions and have a different utility

To be continued: family planning continuation among the urban poor in Senegal, a prospective, longitudinal descriptive study. [version 1; referees: 2 approved]

Background: Given the role that continued use of family planning (FP) by current users plays in increasing contraceptive prevalence rates (CPR), this research aims to measure method-specific continuation rates for fixed-site and community-based program interventions and to document reasons for discontinuation.  Methods: This research compared discontinuation rates for clients initiating family planning through two types of strategies—services provided at existing health centers that provided regular, ongoing services, and “one-off” outreach services in communities.  Data collectors surveyed consenting clients who were initiating a modern method, or reinitiating after a break of at least six months, and conducted a follow up survey after seven months.  Results: Long acting reversible contraception (LARC) was more commonly initiated through outreach strategies than through fixed sites. LARC made up 65% of methods initiated through the outreach setting and 47% of those initiated through a fixed-site strategy. Continuation rates varied from 99% for intrauterine devices (IUDs) to 77% for injectables and were very similar between outreach and fixed-site strategies, with the exception of oral contraceptive pills (OCPs). Only 65% of outreach initiators continued using OCPs, compared to 84% of fixed-site initiators. Top reported reasons for discontinuation were side effects and little or no sexual relations. Conclusions: Project interventions allowed most women to continue with their chosen method of FP for the seven-month duration of the study whether initiated through fixed site or outreach strategies, showing promise in helping Senegal to increase its CPR. It is feasible to offer both LARC and short acting methods through outreach strategies.  Further research into the sensitivity of demand to the price charged is needed

Can village savings and loan groups be a potential tool in the malnutrition fight? Mixed method findings from Mozambique

Child malnutrition is a pervasive problem in sub-Saharan Africa that affects individual and national development. This article examines the impact of participation in village savings and loan (VSL) groups, alone and in combination with a rotating labor scheme called Ajuda Mútua (AM), on household and child nutritional outcomes in Nampula Province in Mozambique. It combines findings from an impact evaluation and a qualitative exploration of the dynamics underlying nutritional outcomes.Three pairs of districts were randomly allocated to two interventions (VSL or VSL. +. AM) or control. The impact evaluation utilized a prospective, longitudinal design. In total, 1276 households were surveyed at baseline in 2009 and three years later. Difference-in-difference propensity score matching models estimated program impacts on months of food sufficiency and household dietary diversity scores (HDDS) at the household level, and on individual dietary diversity scores (IDDS) and weight-for-age at the child level. In the qualitative study, in-depth interviews (IDIs) were completed with a subset of 36 VSL and 36 VSL. +. AM participants from two districts who had taken part in the two surveys. Transcripts were analyzed using thematic analysis.Survey data indicate that both interventions had a statistically significant, positive effect on months of food sufficiency. The HDDS increased for VSL. +. AM households and their matched controls; however, the increase was smaller for the VSL. +. AM group. The difference in increase between the two groups was statistically significant. At the child level, participation in VSL only was found to increase the IDDS. There was no significant effect for weight-for-age. Mean values for both the HDDS and the IDDS remained low. IDIs confirmed that there were improvements in seasonal and transitory food insecurity, which occur when recurring periods of extreme scarcity or sporadic crises are experienced. Due to the timing of the cycle, VSLs provided participants with an infusion of cash to purchase food during the hunger season. VSLs and AMs also offered mechanisms to cope with unexpected events through loans and social support. However, IDIs highlighted lack of money as a persistent challenge in accessing foods to supplement home-grown staples for a diversified nutritional intake. Though parents tended to be aware of the nutritional needs of children, they faced financial constraints in meeting them. There were also indications of a sex gap between control over resources by men and the role played by women in child nutrition.Findings underscore the potential of economic-strengthening activities such as VSLs for improving seasonal and transitory food security, but highlight the need for additional supporting interventions in order to overcome chronic nutritional challenges

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

Expanding Understanding of Community Health Worker Programs: A Cross-Sectional Survey on the Work, Satisfaction, and Livelihoods of CHWs in Madagascar

With health worker shortages in rural areas, community health workers (CHWs) are instrumental to the sustainability of primary health care and to the ability to meet health needs. Identifying appropriate operational models and incentive structures is an important element of long-term success. This article reports on CHWs’ work demands and affective response to their volunteer work within the broader context of their livelihoods in Madagascar. A cross-sectional survey of 874 CHWs, called Agents de Santé Communautaire (ACs), from 14 districts across 5 regions was conducted in June 2015. Only 44% of ACs had cash savings. Subsistence farming was the main livelihood strategy; ninety-two percent of ACs were food insecure and 89% had experienced a shock in the past year. Overall, 77% of ACs financed commodity resupply through sales of health products and 18% from their personal savings; stock-outs at point of supply and financial and time constraints were the main reported challenges in getting health products. The average satisfaction score with AC work was 3 out of 4. This assessment from Madagascar helps unveil a more comprehensive view of the reality of CHWs’ lives. Managers need to take into account the potential implications of the demands of CHW work on already precarious livelihoods

User preferences for a contraceptive microarray patch in India and Nigeria: Qualitative research on what women want.

BackgroundA new contraceptive microarray patch (MAP) for women is in development. Input on this method from potential end-users early in the product development process is important to guide design decisions. This paper presents the qualitative component of a broader study exploring initial acceptability of the MAP and selected product features. The qualitative research was intended to identify product features that are most salient to end-users and to contextualize preferences around them with subsequent research planned to assess quantitatively the relative importance of those features.MethodsWe conducted 16 focus group discussions and 20 in-depth interviews with women and 20 IDIs with family planning providers in New Delhi, India, and Ibadan, Nigeria. Input from the MAP developer served to identify plausible features of the MAP to include in the focus group discussions and in-depth interviews. Interviews were audio-recorded, transcribed into English, coded, and analyzed to examine key dimensions of MAP features.ResultsMany participants viewed the MAP as potentially easy to use. Interest in self-application after learning correct use was high, especially in India. Participants favored formulations affording protection from pregnancy for three or six months, if not longer. Interest in a shorter-acting MAP was particularly low in Nigeria. Non-desirable MAP features included a potential localized skin rash and pain at application. Views on patch size and location of application were related to the potential for rash and pain, with a desire to permit discreet use and minimize pain. Results indicate that the side effect profile, effectiveness, and pricing are also important factors for acceptability and uptake of a future product.ConclusionStudy findings indicate that a contraceptive MAP is of potential interest to women and that specific MAP attributes will be important to acceptability

Integrating family planning and HIV services at the community level: formative assessment with village health teams in Uganda

Little is known on integrating HIV and family planning (FP) services in community settings. Using a cluster randomized controlled design, we conducted a formative assessment in two districts in Uganda where community health workers, called VHTs, already offered FP. Thirty-six trained VHTs also provided HIV testing and counseling (HTC) during the intervention. We surveyed all 36 VHTs and 256 FP clients, and reviewed service statistics. In the intervention group, VHTs tested 80% of surveyed clients for HIV, including 76% they already saw for FP and 22% who first came to them for HTC before receiving FP. Comparing clients‘ experiences in the intervention and control groups, adding HTC does not appear to have negatively affected FP service quality. VHTs reported more monthly clients, but rated their workload as easy to manage. This integrated model seems feasible and beneficial for both VHTs and clients, while not resulting in any negative effects. This study was registered with ClinicalTrials.gov, number [NCT02244398].Keywords: family planning, HIV, community health workers, integration, Ugand

Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Little is known on integrating HIV and family planning (FP) services in community settings. Using a cluster randomized controlled design, we conducted a formative assessment in two districts in Uganda where community health workers, called VHTs, already offered FP. Thirty-six trained VHTs also provided HIV testing and counseling (HTC) during the intervention. We surveyed all 36 VHTs and 256 FP clients, and reviewed service statistics. In the intervention group, VHTs tested 80% of surveyed clients for HIV, including 76% they already saw for FP and 22% who first came to them for HTC before receiving FP. Comparing clients‘ experiences in the intervention and control groups, adding HTC does not appear to have negatively affected FP service quality. VHTs reported more monthly clients, but rated their workload as easy to manage. This integrated model seems feasible and beneficial for both VHTs and clients, while not resulting in any negative effects. This study was registered with ClinicalTrials.gov, number [NCT02244398].  Keywords: family planning, HIV, community health workers, integration, Uganda Peu d‘informations sont disponibles sur l'intégration des services de planification familiale (PF) et du VIH dans les milieux communautaires. En utilisant un plan randomisé contrôlé par grappes, nous avons mené une évaluation formative dans deux districts en Ouganda dans lesquels les agents de santé communautaire qui sont appelés VHT offraient déjà des services de PF. Trente-six VHT formés ont également fourni des services de conseil et dépistage du VIH (CDV). Nous avons enquêté les 36 ASC et 256 clientes PF, et nous avons examiné les statistiques sur les services. Dans le groupe d'intervention, les VHT ont testé 80% des clients enquêtées pour le VIH, y compris 76% que les VHT voyaient déjà pour la PF et 22% qui sont d‘abord venus pour le CDV avant avant de recevoir la PF. En comparant les expériences des clientes dans les groupes avec et sans intervention, l‘ajout du CDV ne semble pas avoir affecté négativement la qualité des services PF. Les VHT ont signalé plus de clients mensuellement, mais ont évalué leur charge de travail comme étant aussi facile à gérer. Ce modèle intégré semble faisable et bénéfique pour les VHT et les clients, et sans entraîner d‘effet négatif. Cette étude a été enregistrée auprès de ClinicalTrials.gov, numéro [NCT02244398].Mots clés: planification familiale, VIH, agents de santé communautaires, intégration, Ougand