Meeting rural demand: a case for combining community-based distribution and social marketing of injectable contraceptives in Tigray, Ethiopia.

BackgroundIn Sub-Saharan Africa, policy changes have begun to pave the way for community distribution of injectable contraceptives but sustaining such efforts remains challenging. Combining social marketing with community-based distribution provides an opportunity to recover some program costs and compensate workers with proceeds from contraceptive sales. This paper proposes a model for increasing access to injectable contraceptives in rural settings by using community-based distributers as social marketing agents and incorporating financing systems to improve sustainability.MethodsThis intervention was implemented in three districts of the Central Zone of Tigray, Ethiopia and program data has been collected from November 2011 through October 2012. A total of 137 Community Based Reproductive Health Agents (CBRHAs) were trained to provide injectable contraceptives and were provided with a loan of 25 injectable contraceptives from a drug revolving fund, created with project funds. The price of a single dose credited to a CBRHA was 3 birr ($0.17) and they provide injections to women for 5 birr ($0.29), determined with willingness-to-pay data. Social marketing was used to create awareness and generate demand. Both quantitative and qualitative methods were used to examine important feasibility aspects of the intervention.ResultsForty-four percent of CBRHAs were providing family planning methods at the time of the training and 96% believed providing injectable contraceptives would improve their services. By October 2012, 137 CBRHAs had successfully completed training and provided 2541 injections. Of total injections, 47% were provided to new users of injectable contraceptives. Approximately 31% of injections were given for free to the poorest women, including adolescents.ConclusionsInsights gained from the first year of implementation of the model provide a framework for further expansion in Tigray, Ethiopia. Our experience highlights how program planners can tailor interventions to match family planning preferences and create more sustainable contraceptive service provision with greater impact

Column expansion identities and quadratic spanning forest identities

Column expansion identities of determinants give a source of quadratic spanning forest polynomial identities and allow us determine the dimension of the space of certain quadratic spanning forest identities, settling a conjecture of one of us with Vlasev from 2012. Furthermore, we give a combinatorial interpretation of such spanning forest identities via an edge-swapping argument previously developed by one of us in 2019. Quadratic spanning forest polynomials identities are of particular interest because they are useful for quantum field theory calculations in four dimensions.Comment: 31 pages, added a very brief QFT motivatio

The Gwich'in Traditional Caribou Skin Clothing Project: Repatriating Traditional Knowledge and Skills

... The Gwich'in are the most northerly of the Athapaskan peoples occupying parts of the Yukon River drainage in Alaska and the Yukon Territory, and the northern Mackenzie Basin of the Northwest Territories. The project described here was sponsored by the Gwich'in who reside in the Northwest Territories. Traditionally their lands extended from the interior of the Yukon into the Mackenzie Basin and included the watersheds of the Peel, Mackenzie, and Arctic Red Rivers. Today, most NWT Gwich'in live in the four communities of Aklavik, Fort McPherson, Inuvik, and Tsiigehtchic (formerly called Arctic Red River). These communities all fall within the Gwich'in Settlement Area that was established by the Gwich'in Comprehensive Land Claim Agreement signed in 1992 with the Government of Canada. People in the Gwich'in Settlement Area are greatly interested in materials that were collected in earlier times and are now housed throughout the world in museums, archives, and private collections. These items represent a bygone era and have great historical, cultural, and sometimes spiritual meaning. Of particular interest is traditional Gwich'in summer clothing made of white caribou hides, sewn with sinew, and decorated with porcupine quills, trade beads, silverberry seeds, finges, and ochre. Distinctively styled and striking to look at, these garments are a testament to Gwich'in women's great skill and artistic expression. ... It has been well over 100 years since Gwich'in traditional caribou skin clothing was made, and there are no examples of this clothing in either the Gwich'in communities or the Northwest Territories today. It has been over 50 years since porcupine quillwork was used as the primary decorative motif on Gwich'in jackets, slippers, and gloves. For the past two years, the Gwich'in Social and Cultural Institute (GSCI) has worked in partnership with the Prince of Wales Northern Heritage Centre (PWNHC) to create five replicas of a multipiece 19th-century Gwich'in traditional summer outfit that is housed at the Canadian Museum of Civilization (CMC). The project has given us an opportunity to document, understand, and appreciate how this clothing was manufactured and the extraordinary amount of time, knowledge, and skill that Gwich'in women needed to clothe their families and protect them from the elements. It has also helped to repatriate skills and knowledge no longer practiced in the Gwich'in Settlement Area

Mindfulness and Indigenous Knowledge: Shared Narratives About Reconciliation and Decolonization in Teacher Education

This article discusses how shared narratives about mindfulness practices and Indigenous knowledge advance the reconciliation and the decolonization of Teacher Education curricula. We, the authors, experienced the beneficial impact of our personal mindfulness practices in nurturing and cultivating the harmonious balance of the physical, emotional, mental, and spiritual dimensions of the self. Within the context of the Truth and Reconciliation’s Calls to Action (2015), we observed the connections between mindfulness practices and local and place-based teachings of First Nation and Métis First Peoples in Northern British Columbia and in the Interior of British Columbia, Canada. Our experiences are informed by our personal mindfulness practices and from traditional and ancestral practices led by Elders and Knowledge Keepers. Our distinct narratives describe our learnings and our unlearnings as we participated in ceremony and listened and learnt from Elders and Knowledge Keepers of Syilx Okanagan Nation, Lheidli T’enneh First Nation, the Māori Nation, and the Métis Nation of Manitoba. By recognizing and respecting ancestral ways of doing and ways of being, we propose that contemplative practices like mindfulness can support a deeper understanding of how reconciliation and decolonizing are brought to the forefront of shared narratives in Teacher Education programs in the Okanagan and in Prince George

Faecal Haemoglobin Estimated by Faecal Immunochemical Tests:An Indicator of Systemic Inflammation with Real Clinical Potential

Multimorbidity is the major cause of ill-health and premature death in developed countries. The ability to identify individuals at risk of developing chronic disease, particularly multimorbidity, reliably, and simply, and to identify undiagnosed disorders, is vital to reducing the global burden of disease. This narrative review, the first of recent studies, demonstrates that raised faecal haemoglobin concentration (f-Hb) is associated with increased all-cause and cause-specific mortality and with longer-term conditions including diabetes, hypertension, cardiovascular disease, and psoriasis, and with probable intake of particulate matter. We and others have hypothesized that elevated f-Hb (measured using a faecal immunochemical test) has considerable potential to identify individuals at risk of, or who already have, early stage, undiagnosed chronic disease. If f-Hb does prove to be an effective biomarker for chronic disease and multimorbidity, individuals with detectable f-Hb, but without an obvious source of gastrointestinal blood loss, could benefit from further assessment and early intervention. To test this hypothesis rigorously, longitudinal data-linkage methodology is required linking colorectal cancer screening data, and data on patients presenting with lower gastrointestinal symptoms, with routinely collected health information

Systematic Review of the Addition of Hip Strengthening Exercises for Adults with Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal disorder typically occurring in physically active people aged 40 years and younger, causing pain, functional deficits and lower limb weakness. Traditional treatment has been aimed at strengthening the knee, however recent research suggests the muscles around the hip also play an important role in the development and continuity of Patellofemoral Pain Syndrome. Purpose: To investigate the effectiveness of the addition of hip strengthening exercises to standard physiotherapy treatment (knee strengthening and stretching exercises) on reducing pain, and enhancing strength and function when compared to standard physiotherapy treatment alone in adults with Patellofemoral Pain Syndrome. Method: A systematic search of Cochrane, CINAHL, Embase, MEDLINE®, PEDro and SportDiscus was conducted. Studies of participants aged 18 to 44, diagnosed with Patellofemoral Pain Syndrome by a healthcare practitioner, or reporting peripatellar or retropatellar pain with common functional tasks, were included. A critical appraisal, using the Critical Appraisal Skills Program for Randomised Controlled Trials (CASP) was used to assess methodological quality. Results: Five randomised controlled trials of varying methodological quality met the inclusion criteria. The participants in these studies were aged between 18 to 40 years of age. The duration of the intervention ranged from four to six weeks consisting of 12 to 30 supervised exercise sessions. Studies used varying outcome measures for each of the three outcomes. Overall, the studies demonstrated that the addition of hip strengthening exercises to standard physiotherapy care consistently improved pain and function, but the impact on strength was variable. Conclusion: Previously, only a small number of studies have looked at the addition of hip exercises to standard physiotherapy care for treatment of Patellofemoral Pain Syndrome. While there is a growing body of evidence for the efficacy of hip strengthening exercises for Patellofemoral Pain Syndrome, this is constrained by bias towards female participants, lack of true controls in most studies, and low methodological quality of studies overall. Hip exercises added to standard physiotherapy care shows potential as a treatment method for improving outcomes of pain and function in adults with Patellofemoral Pain Syndrome