Public Health Commons^™

The Rationale And Relevance Of Existing Cadres Of Frontline Health Workers And Potential For New Mid-Level Cadres, Oladimeji Oladepo, Ekechi Okereke, Akinwumi Akinola

Reproductive Health

Front-line health workers (FLHWs) are expected to perform necessary maternal, newborn, and child (MNCH) services appropriately and effectively; however, few studies have investigated the extent to which FLHWs perform requisite primary health care (PHC) services. This study seeks to better understand not only FLHWs’ knowledge and performance of MNCH services, but the factors promoting and inhibiting their services in selected rural local government areas of Nigeria’s Bauchi and Cross River states. It also investigates the potential for a new PHC worker cadre, soliciting stakeholders’ perceptions about its feasibility for addressing maternal and newborn disease burdens in rural communities. The study’s …

Tracing Change In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Narok And Kisii Counties, Kenya, Dennis Matanda, Chantalle Okondo, Caroline W. Kabiru, Bettina Shell-Duncan

Reproductive Health

In Kenya, there has been a steady and marked decline in the prevalence of female genital mutilation/cutting (FGM/C) but there is great variance in the prevalence of FGM/C across the country, with prevalence remaining high among certain ethnic groups such as Somali, Samburu, Kisii, and the Maasai. The objectives of this study were: 1) to explore whether and how unprogrammed factors or programmed FGM/C interventions (alternative rites of passage, legal and policy measures, religious-oriented approaches, promotion of girls’ education, intergenerational dialogues, use of rescue centers, and other undocumented approaches) influence community values deliberation in Narok and Kisii counties; 2) to …

Trends In Medicalisation Of Female Genital Mutilation/Cutting: What Do The Data Reveal?, Bettina Shell-Duncan, Carolyne Njue, Zhuzhi Moore

Reproductive Health

Despite the emergence of international consensus that female genital mutilation/cutting (FGM/C) is a violation of human rights, a focus on medicalization remains salient because of concerns that FGM/C is increasingly being performed by healthcare professionals and may be impeding progress toward abandonment of FGM/C. To investigate these claims, this study draws on nationally representative survey data from 26 countries, and addresses the following three questions: 1) What are the major patterns and trends in medicalisation? 2) Is there an association between medicalization and rates of change in prevalence of FGM/C? and 3) Is there an association between medicalization and support …

Understanding Medicalisation Of Female Genital Mutilation/Cutting (Fgm/C): A Qualitative Study Of Parents And Health Workers In Nigeria, Otibho Obianwu, Adetayo Adetunji, Osasuyi Dirisu

Reproductive Health

This community-based, cross-sectional qualitative study was conducted in four communities in Nigeria’s Delta, and was conceptualized to address gaps in our understanding of medicalization of female genital mutilation/cutting (FGM/C) and to provide critical evidence needed to effectively design abandonment interventions. The study findings reveal that the social norms driving FGM/C practice remain entrenched despite a shift to medicalization. They also reflect the tendency of parents and health workers to view FGM/C, whether traditional or medicalized, as a minor procedure with few complications and significant benefits that would positively impact a daughter’s future status as a wife and mother. Findings reveal …

Understanding The Key Elements For Designing And Implementing Social Marketing Campaigns To Inform The Development Of Creative Approaches For Fgm/C Abandonment In Sudan, Widad Ali A/Rahman, Samia Al Nagar, Randa H. Gindeel, Arwa Salah

Reproductive Health

Social marketing campaigns (SMCs) have gained prominence in female genital mutilation/cutting (FGM/C) abandonment efforts, but there is a dearth of information on how these programs are designed and implemented, and their perceived impact. Understanding the implementation process and the effectiveness of these campaigns is critical for drawing lessons to improve existing programs and inform the design and scale up of SMCs in other regions/countries. This mixed-method study sought to address this gap by assessing the design and implementation of existing SMC programs in Sudan. While the study findings demonstrate several strengths of existing programs, including strong partnerships and extensive needs …

Retrospective Cohort Study: Clinical Presentation And Outcomes Of Pre-Eclampsia And Eclampsia At Kenyatta National Hospital, Nairobi, Kenya, Charity Ndwiga, Alfred Osoti, Pooja Sripad, George Odwe, Omondi Ogutu, Charlotte E. Warren

Reproductive Health

Pre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for …

Insights And Evidence Gaps In Girl-Centered Programming: A Systematic Review, Nicole Haberland, Katharine Mccarthy, Martha Brady

Poverty, Gender, and Youth

Increased attention to the needs of adolescent girls has led to a growing number of programs in low- and middle-income countries. Questions remain, however, about what aspects of program design are most effective. This hinders efforts to effectively allocate resources, scale up programs, and replicate results across settings. This review looks at how the number of program components, involvement of supporting actors who influence the lives of girls, supplemental “booster” activities, intervention exposure level, and community saturation level influenced outcomes for girls. While findings suggest the importance of multicomponent programs and longer program exposure, each area requires further rigorous research …

Delivering Impact For Adolescent Girls: Emerging Findings From Population Council Research, Population Council

Poverty, Gender, and Youth

Despite numerous global commitments to invest in improving the lives of adolescent girls, questions remain as to what package of interventions can deliver the best outcomes. This report synthesizes findings from nine recent Population Council impact evaluations, conducted around the world, which indicate that empowerment and asset-building interventions for adolescent girls can improve education, health, economic, social capital, gender-equitable attitude, and violence outcomes for girls. The report includes implications for programs and investment, and identifies open questions for further research and evaluation.

Black Males, Trauma, And Mental Health Service Use: A Systematic Review., Robert Motley, Andrae Banks

Brown School Faculty Publications

Objective: To systematically review the evidence of and synthesize results from relevant studies that have examined barriers and facilitators to professional mental health service use for Black male trauma survivors ages 18 and older.

Methods: A thorough search of selected databases that included EBSCO, ProQuest, and Web of Science Core Collection and careful consideration of inclusion and exclusion criteria yielded a final six studies for detailed review.

Results: Black male trauma survivors were significantly less likely to be utilizing mental health services than other sex-ethnic groups. High levels of daily crises, a lack of knowledge of steps to …

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 …

Moving Mountains : A Study Examining Long-Term Impacts Of Mountaintop Removal Coal Mining On Mortality In The Appalachian Region Using Geographic Information Sciences Techniques., James Howard Kent Pugh

Electronic Theses and Dissertations

Over the last hundred years, the Appalachian region has been dominated by the coal industry. It has also been and currently is one of the unhealthiest regions in the United States. Recent scholarship has examined the relationship between coal mining and health and mortality rates in the Appalachian region. The first study incorporates air quality and pollution data to examine if coal mining counties have higher levels of pollution and if this pollution contributes to mortality disadvantage. In the second study, I construct a population-based coal-exposure measure to better evaluate the relationship between coal mining and health I find that …

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 …

Swedish Social Welfare And Its Application To American Welfare Systems, Ben Wilson Galloway

Graduate Theses and Dissertations

Swedish Social Welfare and its Application to American Welfare Systems concerns itself with the issue of determining the origins of the modern Swedish social welfare system. Additionally, the causes behind the formation of the system are evaluated for their relevancy concerning the formation of the American welfare system. Multiple areas of study are considered, including racial impacts, economic factors, sociological impactors, and demographic variables.

A Guide For Assessing Older Adults’ Needs On Maine Islands, Beatrice Byrne

Muskie School Capstones and Dissertations

This template may help Maine island communities identify older adults’ needs and island resources, in order to allow older adults to age in the island communities.

Three interviews with island health leaders, one community conversation with older islanders, and one pilot test provided information about what to include in the template.

The template includes a demographic survey, guides for conducting semi-structured interviews and group conversations with older adults and caregivers, a guide and worksheet for analyzing the data, a guide for assessing community resources, a guide for dissemination, and a list of additional resources.

Neighborhood Deprivation, Food Insecurity And Gestational Weight Gain, Sabrina Luke

USF Tampa Graduate Theses and Dissertations

Gestational weight gain outside the recommended ranges puts women at risk for pregnancy complications and adverse birth outcomes. Food insecurity and environmental factors including neighborhood deprivation may influence gestational weight gain. This research 1) examines the impact of neighborhood deprivation on gestational weight gain, 2) identifies if the association varies by selected maternal characteristics, 3) examines the relationship between food insecurity and gestational weight gain, 4) determines if stress mediates the relationship between food insecurity and gestational weight gain, and 5) examines whether selected maternal characteristics mediate this relationship. The research was conducted through the analysis of the Pregnancy Risk …

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 …

Race, Age, And Neighborhood Socioeconomic Status In Low Birth Weight Disparities Among Adolescent Mothers: An Intersectional Inquiry, Sheryl L. Coley, Tracy R. Nichols

Journal of Health Disparities Research and Practice

Introduction: Few studies examined socioeconomic contributors to racial disparities in low birth weight outcomes between African-American and Caucasian adolescent mothers. This cross-sectional study examined the intersections of maternal racial status, age, and neighborhood socioeconomic status in explaining these disparities in low birth weight outcomes across a statewide sample of adolescent mothers.

Methods: Using data from the North Carolina State Center of Health Statistics for 2010-2011, birth cases for 16,472 adolescents were geocoded by street address and linked to census-tract information from the 2010 United States Census. Multilevel models with interaction terms were used to identify significant associations between maternal racial …

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 …

Private Sector Costing Of Voluntary Medical Male Circumcision In South Africa, Michel Tchuenche, Steven Forsythe

HIV and AIDS

In 2010, after voluntary medical male circumcision (VMMC) had been shown to be one of the most cost-effective strategies for preventing HIV infections, South Africa initiated a VMMC program with an ambitious target of performing 4.3 million circumcisions by 2016. However, because of a gap in knowledge concerning the overall cost of scaling up services, the South African National Department of Health requested that Project SOAR—Supporting Operational AIDS Research—conduct a private-sector costing of providing VMMC services in South Africa. The findings presented in this report provide a detailed investigation, through a comprehensive bottom-up approach, of the costs to private providers …

Stakeholder Considerations For Prep Introduction To Adolescent Girls And Young Women: Laying The Groundwork For Research Utilization In Tanzania, Population Council

HIV and AIDS

In collaboration with the Tanzania National AIDS Control Programme and CSK Research Solutions Ltd., the Population Council is conducting an implementation science research study in that country to build needed evidence to inform decisionmaking around oral pre-exposure prophylaxis (PrEP) introduction to adolescent girls and young women (AGYW) aged 15–24. The study uses quantitative and qualitative methods to gather data from AGYW, policymakers and other stakeholders, health providers, and AGYW’s parents and male partners to: assess their knowledge and attitudes toward oral PrEP; determine opportunities and approaches for providing PrEP; and identify potential facilitators and barriers to PrEP introduction and use. …

Policymakers' Perceptions Of Oral Pre-Exposure Prophylaxis Introduction In Tanzania: Findings From Implementation Science Research, Population Council

HIV and AIDS

There is limited evidence from Tanzania to inform decisionmaking on whether and how to introduce oral pre-exposure prophylaxis (PrEP) to adolescent girls and young women (AGYW). To help fill this evidence gap, the Population Council in collaboration with the National AIDS Control Program and CSK Research Solutions Limited conducted implementation science research in one urban district (Dar es Salaam) and one rural district (Mbeya) in Tanzania to explore policymakers’ and key stakeholders’ perceptions and attitudes toward the introduction of PrEP to different groups, including AGYW, as well as to identify key issues that must be considered prior to its introduction. …

Training Locally Elected Representatives To Act As Change Agents To Promote Egalitarian Gender Norms: Lessons Learned From The Do Kadam Barabari Ki Ore Programme—Policy Brief, K.G. Santhya, Shireen J. Jejeebhoy

Poverty, Gender, and Youth

This policy brief describes an intervention, the Do Kadam Barabari Ki Ore (Two Steps Towards Equality) project in Patna district, India that sought to train locally elected representatives to act as change agents to promote egalitarian gender norms among men and women in their communities, and the effects of exposure to the project among members of the Panchayati Raj Institutions (PRIs, local self-governance bodies) and men and women from the community. The project was undertaken by the Population Council, together with partners, the Centre for Catalysing Change and the London School of Hygiene and Tropical Medicine, and with support from …

Adolescent Girls And Young Women’S Perceptions Of Oral Pre-Exposure Prophylaxis Introduction In Tanzania: Findings From Implementation Science Research, Population Council

HIV and AIDS

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 pre-exposure prophylaxis (PrEP) antiretroviral medication to adolescent girls and young women (AGYW) at substantial risk of HIV infection. This brief presents results from qualitative in-depth interviews and focus group discussions with AGYWs. Based on the findings, the brief recommends including sensitization and education of communities, parents, and male partners of AGYWs in demand-creation activities; training providers to deliver adequate education about PrEP to avoid misperceptions about its intended use, side effects, and …

Are We Meeting The Hiv Service Needs Of People Living In Informal Settlements In Kwazulu-Natal, South Africa?, Project Soar

HIV and AIDS

This brief summarizes the characteristics and circumstances of approximately 1,500 men and women living in 18 informal settlements in KwaZulu-Natal, South Africa. The data come from a baseline survey conducted in mid-2017 as part of an evaluation of the PEPFAR/USAID-funded Asibonisane Community Responses program. Project SOAR/Population Council conducted the evaluation in partnership with the MatCH Research Unit at the University of Witwatersrand. The findings presented here highlight the need for HIV treatment services to be more responsive to residents living with HIV in informal settlements. Furthermore, continued efforts are needed to reduce HIV risk and intimate partner violence among young …

Assessing Hiv-Related Outcomes Among Key Populations Accessing Community-Based Test And Start Services In Nigeria, Project Soar

HIV and AIDS

This activity brief describes a research study Project SOAR is conducting to better understand how to use existing key population community platforms in Nigeria to expand access to HIV treatment, the cost of such care provided outside of clinical health facilities, and the extent to which false positive misclassification may occur in outreach settings. Given the global “treat all” emphasis and the need to effectively scale up test and start services and minimize misclassification rates, these findings will be important in expanding timely antiretroviral treatment coverage in vulnerable communities in Nigeria and elsewhere.

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.

Assessment Of Comprehensive Hiv-Risk Reduction Programming For Adolescent Girls And Young Women: Implementation Science Research In Zambia, 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 Zambia and similar ones in Kenya 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.

Assessment Of The Implementation Of The Treat-All Guidelines (Test And Start) In Namibia, Project Soar

HIV and AIDS

The Government of Namibia has adopted “treat-all” guidelines, commonly referred to as test and start (TnS), as a national policy effective April 2017. These guidelines recommend that anyone who has tested positive for HIV should begin antiretroviral therapy (ART) as soon as possible. This brief describes the proposed research of a study team led by the Population Council to generate evidence on how the national rollout of the TnS guidelines and decentralization of ART services affect client-level treatment outcomes, quality of ART services, and treatment costs in Namibia. The results of this study will inform the implementation and scale-up of …

Characteristics Associated With Hiv And Hsv-2 Among Adolescents In Malawi, Barbara Mensch, Erica Soler-Hampejsek

HIV and AIDS

The DREAMS (Determined, Resilient, Empowered AIDS-free, Mentored, and Safe) partnership aims to significantly reduce new HIV infections in adolescent girls and young women (AGYW) in Malawi and other sub-Saharan African countries. To better understand the epidemiological context for the DREAMS programming, Project SOAR analyzed previously collected quantitative cohort data from the Population Council’s Malawi Schooling and Adolescent Study to identify the factors associated with the prevalence and incidence of HIV and the herpes simplex virus, commonly referred to as genital herpes. SOAR’s analysis provides a deeper understanding of the epidemiological and gendered context of the HIV epidemic in Malawi. This …