Medicine and Health Sciences Commons^™

Negative Outcomes Of Teen Sexual Activity: Is There A Regional Effect?, Hannah Latta, Said Shahtahmasebi, Hatim A. Omar

Pediatrics Faculty Publications

A recent victory with respect to teen sexual behavior is the reduction of the national teen birth rate. In 1991, there were 61.8 births per 1000 females aged 15-19. By 2014, this rate plummeted to 24.2 births per 1000 adolescent females. Averages, however, do not reflect state-level variation. For example, in 2014, Kentucky reported 35.3 births per 1000 adolescent females, while New York reported a teen birth rates of 16.1 births per 1000 adolescent females. This report asks: are these discrepancies due to regional factors, and are these differences statistically significant? To examine rural and urban differences in outcomes of …

How Useful Is Gsv As An Environmental Observation Tool? An Analysis Of The Evidence So Far., Katherine Nesse, Leah Airt

SPU Works

Researchers in many disciplines have turned to Google Street View to replace pedestrian- or carbased in-person observation of streetscapes. It is most prevalent within the research literature on the relationship between neighborhood environments and public health but has been used as diverse as disaster recovery, ecology and wildlife habitat, and urban design. Evaluations of the tool have found that the results of GSV-based observation are similar to the results from in-person observation although the similarity depends on the type of characteristic being observed. Larger, permanent and discrete features showed more consistency between the two methods and smaller, transient and judgmental …

Health-Related Quality Of Life Variations By Sociodemographic Factors And Chronic Conditions In Three Metropolitan Cities Of South Asia: The Carrs Study, Kavita Singh, Dimple Kondal, Roopa Shivashankar, Mohammed K. Ali, Rajendra Pradeepa, Vamadevan S. Ajay, Viswanathan Mohan, Muhammad Masood Kadir, Mark Daniel Sullivan, Nikhil Tandon, K M Venkat Narayan, Dorairaj Prabhakaran

Community Health Sciences

Objectives: Health-related quality of life (HRQOL) is a key indicator of health. However, HRQOL data from representative populations in South Asia are lacking. This study aims to describe HRQOL overall, by age, gender and socioeconomic status, and examine the associations between selected chronic conditions and HRQOL in adults from three urban cities in South Asia.
Methods: We used data from 16 287 adults aged ≥20 years from the baseline survey of the Centre for Cardiometabolic Risk Reduction in South Asia cohort (2010-2011). HRQOL was measured using the European Quality of Life Five Dimension-Visual Analogue Scale (EQ5D-VAS), which measures health status …

Impact Of Home Visit Capacity On Genetic Association Studies Of Late-Onset Alzheimer's Disease, David W. Fardo, Laura E. Gibbons, Shubhabrata Mukherjee, M. Maria Glymour, Wayne Mccormick, Susan M. Mccurry, James D. Bowen, Eric B. Larson, Paul K. Crane

Biostatistics Faculty Publications

INTRODUCTION—Findings for genetic correlates of late-onset Alzheimer's disease (LOAD) in studies that rely solely on clinic visits may differ from those with capacity to follow participants unable to attend clinic visits.

METHODS—We evaluated previously identified LOAD-risk single nucleotide variants in the prospective Adult Changes in Thought study, comparing hazard ratios (HRs) estimated using the full data set of both in-home and clinic visits (n = 1697) to HRs estimated using only data that were obtained from clinic visits (n = 1308). Models were adjusted for age, sex, principal components to account for ancestry, and additional health indicators.

RESULTS …

Social Isolation And Loneliness In Older People: A Closer Look At Definitions, Mary Lou Ciolfi, Frances Jimenez Ba

Disability & Aging

Social isolation and loneliness are related and the terms are often used interchangeably, but they are distinct concepts with different definitions, health impacts, and interventions. Our population is aging and older people are at increased risk for both social isolation and loneliness and the associated negative health consequences. Understanding the important differences between social isolation and loneliness will help us recognize them earlier in vulnerable populations, engage in more meaningful conversations with older adults about their own risks, and will inform the development and delivery of more individualized, meaningful, and cost-effective interventions.

Comprehensive Neighborhood Portraits And Child Asthma Disparities Introduction, Ashley W. Kranjac, Rachel T. Kimbro, Justin T. Denney, Kristin M. Osiecki, Brady S. Moffett, Keila N. Lopez

Sociology Faculty Articles and Research

Objectives Previous research has established links between child, family, and neighborhood disadvantages and child asthma. We add to this literature by first characterizing neighborhoods in Houston, TX by demographic, economic, and air quality characteristics to establish differences in pediatric asthma diagnoses across neighborhoods. Second, we identify the relative risk of social, economic, and environmental risk factors for child asthma diagnoses. Methods We geocoded and linked electronic pediatric medical records to neighborhood-level social and economic indicators. Using latent profile modeling techniques, we identified Advantaged, Middle-class, and Disadvantaged neighborhoods. We then used a modified version of the Blinder-Oaxaca regression decomposition method to …

Strengthening Capacity In Hiv Operations Research: Reflections On A Project Soar Workshop In Johannesburg, South Africa, Project Soar

HIV and AIDS

Capacity strengthening (CS) to support rigorous scientific research is a globally recognized need and central to Project SOAR. Over a four-day period, SOAR conducted a CS workshop to strengthen individual and institutional capacity in HIV operations research, with a particular emphasis on the research utilization process. This brief summarizes the CS activities conducted, insights from the workshop’s organization, and participants’ views of the workshop.

Knowledge Of Pre-Eclampsia And Eclampsia In Bangladesh, Kanij Sultana, Amy Dempsey

Reproductive Health

In Bangladesh between 1,000 and 1,200 women die every year from pre-eclampsia and eclampsia (PE/E), contributing to 20 percent of maternal deaths. It is the country’s second leading direct cause of maternal mortality. In addition to the burden of maternal mortality, when a mother dies her baby is at increased risk of dying during the first year of life. To fully understand community perceptions of PE/E, the Population Council conducted a landscape analysis in 12 upazilas in four districts. This brief presents those research findings, and concludes that stronger awareness of the importance of early antenatal care and of seeking …

Ensuring Adolescents In Uttar Pradesh Stay—And Learn—In School [Hindi], Sapna Desai, Neelanjana Pandey

Poverty, Gender, and Youth

The Government of India has invested in improving education through two key programs for universal access to, and retention in, secondary education. In Uttar Pradesh, the Population Council found high levels of enrollment among younger adolescents, with limited gender disparity. Retention beyond elementary school, however, was low, and learning outcomes—literacy and numeracy—were poor. This policy brief focuses on two challenges to preparing Uttar Pradesh’s adolescents for the future: universal enrollment and retention in secondary school. The brief outlines recommendations that the government invest in secondary schooling, improve school facilities, support and evaluate quality teaching inputs and curriculum changes, remove economic …

Assessment Of Comprehensive Hiv-Risk Reduction Programming For Adolescent Girls And Young Women: Implementation Science Research In Kenya, Population Council

HIV and AIDS

The Population Council is conducting implementation research to build needed evidence to inform decisionmaking around effective implementation of community-based, girl-centered interventions and to assess their effectiveness in reducing HIV vulnerability among adolescent girls and young women (AGYW)—a population in which AIDS is the leading cause of death in the region. Learnings from this study in Kenya and similar ones in Zambia and Malawi will be valuable for informing each country and the region how to implement AGYW programming that goes beyond the health sector to reduce AGYW’s vulnerability to HIV.

Adolescents In Bangladesh: A Situation Analysis Of Programmatic Approaches To Sexual And Reproductive Health Education And Services, Sigma Ainul, Ashish Bajracharya, Laura Reichenbach, Kate Gilles

Reproductive Health

The health of Bangladesh’s 29.5 million adolescents, who make up nearly one-fifth of the country’s total population, is critical to the country’s future, but issues surrounding adolescent sexual and reproductive health (ASRH) remain taboo. ASRH initiatives have been implemented by both the Government of Bangladesh and nongovernmental organizations, but with limited coordination, documentation, or evaluation, making it difficult to know what worked well and what did not. This report presents findings from a comprehensive review and situation analysis of ASRH programming in Bangladesh, carried out by the Evidence Project/Population Council, with financial support from USAID/Bangladesh, as part of a larger …

L’Expérience De Femmes Ayant Subi Une Grossesse Non Désirée Au Sénégal : Une Étude Qualitative, Fatou Mbow, Nafissatou Diop

Reproductive Health

Au Sénégal, l’avortement n’est autorisé que lorsque la vie de la mère est menacée. Depuis 2013, le Comité de plaidoyer pour l’accès à l’avortement médicalisé au Sénégal (plus connu sous le nom de « Taskforce ») mène des activités de plaidoyer pour une révision de la loi. L’avortement est maintenant plus ouvertement discuté, mais la voix des femmes victimes de grossesse non désirée n’est pas entendue. Cette étude documente l’expérience de ces femmes pour fournir des évidences pour le plaidoyer. L’autorisation de l'avortement médicalisée contribuera à respecter les droits humains et de santé des femmes, ainsi qu’à réduire les conséquences …

A Systematic Review Of The Treatment And Management Of Pre-Eclampsia And Eclampsia In Bangladesh, Karen Kirk, Amy Dempsey

Reproductive Health

By 2015, at the conclusion of the Millennium Development Goals, Bangladesh had achieved a reduction in maternal deaths, however, despite the progress, there are still between 5,000 and 6,000 maternal deaths every year, with 20 percent the result of pre-eclampsia and eclampsia (PE/E). To fully understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E at the national level, Ending Eclampsia conducted a systematic review of papers in Bangladesh published between 2000 and 2015 specifically looking at issues around the quality of care, gaps in the evidence, and barriers to accessing PE/E services. The main …

Advocating Corporate Policy Change On Women's Health And Family Planning: Lessons From The Environmental Movement, Matthew Mcfall, Carolyn Rodehau, David Wofford

Reproductive Health

This brief presents key lessons from the environmental movement on effective strategies for driving changes in corporate policies and practices and creating new mechanisms for holding businesses accountable for environmental impacts. Corporate policies and voluntary and “soft law” standards may be unfamiliar to many women’s health advocates, but they are likely to have increasing importance in the years to come. The global health community can learn from the experience of environmentalists on how to engage businesses on Corporate Social Responsibility (CSR) standards and corporate practices around women’s health. The brief offers six recommendations for moving forward.

Charity: A Health Volunteer Success Story, Amy Dempsey

Reproductive Health

Results from Ending Eclampsia’s landscape analysis of seven states in Nigeria served as the catalyst for a training with Community Health Extension Workers (CHEWs) in Nigeria. Researchers conducted observations of client–provider interactions during antenatal care (ANC) visits and assessed healthcare providers’ knowledge of proven risk factors for pre-eclampsia, including chronic hypertension, previous history of PE/E, obesity, pre-existing diabetes or diabetes in pregnancy, advanced maternal age, sickle cell diseases, and connective tissue diseases. The training’s objective was to teach CHEWs how ANC providers can prevent pregnancy-related complications like pre-eclampsia and eclampsia (PE/E). Following the training the CHEWs felt that they can …

Assessment Of The Implementation And The Achievements Of The 3d Approach Within Senegal’S National Family Planning Action Plan (Nfpap), Fatou Mbow, Nafissatou Diop

Reproductive Health

Senegal’s 2012–2015 National Family Planning Action Plan (NFPAP) is based on the 3D approach (Democratization, Demedicalization, and Decentralization). As the plan came to an end and a new one was being developed, the Evidence Project/Population Council conducted a study to document the implementation and achievements of the 3D approach in relation to the NFPAP. This brief offers highlights of the study which used a desk review and qualitative research. It describes lessons learned from the implementation of the approach, and shares good practices that can be adopted by other countries, particularly those of the Ouagadougou Partnership. Finally, the study provides …

Enhancing Frontline Health Workers' Abilities To Improve Mnch Services In Cross River State Through Task Shifting/Sharing, Sylvia Adebajo, Ekechi Okereke, Friday Joseph

Reproductive Health

There is a shortage of qualified and skilled health professionals providing cost-effective maternal, newborn, and child health (MNCH) services in Cross River State, Nigeria. Frontline health workers (FLHWs) have the potential to learn new skills as part of a task-shifting and sharing (TSS) policy. This brief highlights the results of the TSS policy in Cross River state: village health workers identify and refer pregnant women in their communities to antenatal clinics and provide oral medications; community health workers perform initial case management and ensure quick referrals to secondary facilities for specialized care; nurses and midwives deliver MNCH interventions that are …

Contribution Of Contraceptive Discontinuation To Unintended Births In 36 Developing Countries, Population Council

Reproductive Health

High contraceptive discontinuation results in millions of women having an unmet need for contraception. This Population Council study using data from 36 Demographic and Health Surveys shows that contraceptive discontinuation also results in millions of unintended pregnancies and births. This brief recommends attention to issues related to quality of care, such as counseling, to ensure that each woman has the method she needs/wants and uses it correctly. This will help women avoid contraceptive discontinuation and associated unmet need and unintended fertility right from the beginning. As programs become more successful, quality of care will become key to expanding contraceptive use …

Evaluation Of The Effectiveness Of The Herhealth Model For Improving Sexual And Reproductive Health And Rights Knowledge And Access Of Female Garment Factory Workers In Bangladesh, Md. Irfan Hossain, Abdullah Al Mahmud Shohag, Ashish Bajracharya, Ubaidur Rob, Laura Reichenbach

Reproductive Health

The Population Council, under its USAID-funded Evidence Project, partnered with Bangladesh’s Business for Social Responsibility program to conduct operational research to evaluate the effectiveness of the HERhealth model for improving female factory workers’ health, and to find ways to optimize program inputs and processes to support future scale-up of the intervention. This report presents findings from a pre- and post-intervention quantitative study of female factory workers from 10 factories; a qualitative study with factory managers, service providers, and implementing partners; and self-administered retention assessments of the Peer Health Educators from six factories in Dhaka, Gazipur, and Narayanganj districts. Findings from …

Landscape Analysis: Preventing And Managing Pre-Eclampsia And Eclampsia In Pakistan, Population Council

Reproductive Health

The Ending Eclampsia project conducted a landscape analysis to identify policy and program activities, as well as gaps and challenges around the prevention and treatment of PE/E and use of magnesium sulphate at the provincial and district levels in Pakistan. The analysis assessed the practices for PE/E prevention and treatment, prevalence of PE/E, associated complications, and contribution to maternal mortality and morbidity. This landscape analysis was a major study and one of the first of its kind in the country, blending multiple perspectives on provision of care through the public health system for pregnant women facing, or at risk of, …

Modeling And Mapping Of Girls' Female Genital Mutilation/Cutting (Fgm/C) In The Context Of Economic, Social, And Regional Disparities: Kenya Demographic And Health Surveys 1998-2014, Ngianga-Bakwin Kandala, Damaris Kinyoki, Ahmed Sarki, David Gathara, Paul Komba, Bettina Shell-Duncan

Reproductive Health

The aim of this research study is analysis of successive household data for estimating and revealing trends, similarities, and differences in geographic patterns for the burden of female genital mutilation/cutting (FGM/C) and related risk factors among girls ages 14 and younger in Kenya. This Evidence to End FGM/C study, from a coalition led by the Population Council, is intended to contribute to a deeper understanding of the recent burden of FGM/C among the girls within this very young age group, and to enhance knowledge of the geographic distribution of this practice over time. The report will inform current elimination efforts …

Reducing Barriers To Accessing Fistula Repair: Establishing A Baseline In Katsina, Population Council

Reproductive Health

As a partner on the Fistula Care Plus (FC+) project, the Population Council is conducting implementation research that tests solutions to treatment barriers. Formative research in Nigeria’s Katsina State found that a lack of knowledge among lower-level providers and women and families of how the condition occurs, where treatment is available, and the signs and symptoms of obstetric fistula, as well as transportation costs, affect women’s access to screening and repair. Baseline data reveal the necessity of a comprehensive intervention to address fistula treatment barriers in Katsina. Not only do primary healthcare providers lack adequate knowledge of fistula, referral, and …

Risk Factors For Pre-Eclampsia And Eclampsia In Cambodia, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Cambodia.

Resilience And Community Response To Climate-Related Events: Case Studies From Four Countries, Aviva Klein Meyers, Karen Hardee

Reproductive Health

It is important for governments, aid organizations, and researchers to understand how developing communities respond to climate change and how their efforts can be improved within a framework of resilience thinking. This review explores the definition of resilience and, more specifically, community resilience and its components, then presents four case studies of community response to extreme weather events to illustrate community resilience in action. The review is intended to provide context for and inform more detailed exploration of community resilience in integrated programming (specifically, programming designed to improve health, environment, and population outcomes). It is also intended to capture references …

Strengthening The Role Of Patent And Proprietary Medicine Vendors In The Provision Of Injectable Contraception In Nigeria, Salisu Mohammed Ishaku

Reproductive Health

In Nigeria, overall modern contraceptive use is very low, however 60 percent of modern contraceptive services are obtained from private providers, including Patent and Proprietary Medicine (PPM) shops, which provide more than half of these private-sector services. PPM shops are owned by Patent and Proprietary Medicine Vendors (PPMVs) licensed to sell patent or proprietary drugs. Current regulations do not permit PPMVs to sell or administer injectable contraceptives, though, because they are not regarded as sufficiently trained. Given this, it is an opportune time to generate evidence that can drive policy action to formally engage and train PPMVs in the provision …

Using Data To Target And Scale-Up Girls' Support Programs And Child Marriage Prevention, The Evidence Project

Reproductive Health

Though child marriage is declining globally, it is estimated that over 100 million girls under age 18 will be married in the next decade. A 2012 review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that offered incentives, such as conditional cash transfers or provision of school materials, and those that empower girls directly through interventions such as girls’ groups and training. The Berhane Hewan program in Ethiopia (meaning ‘Light for Eve’ in Amharic) was one of the earliest to test child marriage prevention interventions in sub-Saharan Africa. The …

Evaluation Of The Pepfar/Usaid Asibonisane Community Responses Program In Kwazulu-Natal, South Africa, Project Soar

HIV and AIDS

Few programs intended to improve HIV outcomes or modulate gender norms have been rigorously evaluated in South Africa’s informal settlements where nearly 400,000 people live in KwaZulu Natal province alone. There is limited evidence on how to implement large-scale HIV-prevention programming in these contexts. Project SOAR and partners are addressing these knowledge gaps by conducting an evaluation of the PEPFAR/USAID-funded Asibonisane Community Responses Program in South Africa. Specifically, the study will assess the effectiveness of this community-based HIV-prevention program in informal settlements throughout KwaZulu-Natal—one of four provinces where the program is being carried out. This study aims to influence the …

Men's Perceptions Of Prep Use By Their Adolescent And Young Adult Female Partners In Tanzania In Tanzania: Findings From Implementation Science Research, Population Council

HIV and AIDS

Prevailing gender norms about sexuality and relationship power dynamics have been shown to affect how women make decisions about the use of sexual and reproductive health products, including microbicides, condoms, and other contraceptives. It is therefore important to understand male partners’ views of oral pre-exposure prophylaxis (PrEP) to inform how to effectively introduce PrEP among adolescent girls and young women (AGYW) in Tanzania to ensure they use it correctly and consistently. The Population Council, in collaboration with the National AIDS Control Programme and CSK Research Solutions Ltd., conducted implementation science research in Tanzania to identify key considerations for introducing PrEP …

Enabling Adolescent Boys To Adopt Attitudes That Espouse Gender Equality And Oppose Violence Against Women And Girls: Evidence From Rural Bihar—Policy Brief, Shireen J. Jejeebhoy, K.G. Santhya

Poverty, Gender, and Youth

More than a decade after the enactment of the Protection of Women from Domestic Violence Act, 2005, violence against women and girls remains widespread in India, and patriarchal norms and attitudes continue to underpin gender roles. While programs that focus on empowering women and girls are necessary, they are not sufficient in themselves to prevent violence; men and boys are key players, and violence prevention programs must include them. This brief describes an intervention, the Do Kadam Barabari Ki Ore (Two Steps Towards Equality) project, implemented among boys and young men ages 13–21 who were members of youth clubs that …

Assessment Of The Implementation And Achievements Of The 3d Approach In Senegal’S National Family Planning Action Plan—Part 2: Summary Report, Fatou Mbow, Leslie Dubent, Nafissatou Diop, Fatou Ndiaye Turpin, Bocar Mamadou Daff, Babacar Mane

Reproductive Health

Senegal’s 2012–15 National Family Planning Action Plan (NFPAP) is based on the 3D approach (Democratization, Demedicalization, and Decentralization). As the plan came to an end and a new one was being developed, the Evidence Project/Population Council conducted a study to document the implementation and achievements of the 3D approach in relation to the NFPAP. The study documents the approach using a desk review and qualitative research. It describes lessons learned from the implementation of the approach, and shares good practices that can be adopted by other countries, particularly those of the Ouagadougou Partnership. Finally, the study provides evidence for decisionmaking, …