Public Health Commons^™

Shifts In Female Genital Mutilation/Cutting In Kenya: Perspectives Of Families And Health Care Providers, Samuel Kimani, Caroline W. Kabiru

Reproductive Health

Despite compelling reasons and efforts to eradicate female genital mutilation/cutting (FGM/C) in Kenya, the practice has persisted, albeit with some changes. This study sought to understand the shifts in FGM/C among families and healthcare providers from selected Kenyan communities that practice FGM/C. Our findings highlight similarities and differences across three distinct Kenyan communities. FGM/C appears to persist through two models: first, shifts (changes) in the practice, notably cutting at a younger age, lesser cutting; and second, through stability and consistency with minimal change. The two diverse models appear to rely on and sustain social norms that support FGM/C in these …

Strengthening The Integration Of Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Brian Mdawida, Charlotte E. Warren, Melsa Lutomia, Jane Koech, Elizabeth Washika, Aparna Jain

Reproductive Health

Study findings reveal that many Kenyan women living with HIV are comfortable receiving family planning (FP) services from community health volunteers and with proper training and support, community health volunteers have the potential to provide integrated FP/HIV services. Community-based integrated FP/HIV services could help connect women living with HIV who want to prevent or postpone a pregnancy to contraceptive services, which can reduce unintended pregnancies and in turn maternal mortality and vertical transmission of HIV. This implementation research study offers evidence of the feasibility, quality of care, and acceptability of using community health volunteers to integrate family planning into HIV/AIDS …

The Perspectives Of Men In Mexico City About Vasectomy, Isabel Vieitez Martínez, Adriana Ramos

Reproductive Health

As part of World Vasectomy Day, the Population Council Mexico conducted an exploratory study about the reasons and concerns that led men to seek a no-scalpel vasectomy (NSV) during the 24-hour “Vasectomy-athon” in Mexico City in 2017. This study was intended as the first part of a longer cohort study that would follow up with the men, and their partners, to learn about their experiences with the procedure and its effects, if any, on their relationships. Based on the findings, the report recommends that the Mexican Ministry of Health (SSA) continue integrating NSV information, counseling, and services within the National …

The Perspectives Of Men In Mexico City About Vasectomy—Brief, Isabel Vieitez Martínez, Adriana Ramos

Reproductive Health

On November 17, 2017, Mexico City took part in the global World Vasectomy Day campaign promoting men’s participation in family planning, especially through no-scalpel vasectomy (NSV). During the event the Population Council Mexico conducted an exploratory study to better understand the reasons men chose NSV, as well as their concerns before and after the procedure. The study found that the principal reason for seeking NSV among men surveyed was their achievement of a desired family size, for themselves and their partners. The study further reveals the need to disseminate information through mass media, social networks, and all levels of the …

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 …

Does Insulin Therapy Matter? Determinants Of Diabetes Care Outcomes, Jennifer A. Andersen, Larry Gibbs

Department of Sociology: Faculty Publications

Objective: To evaluate adherence to care standards for people with diabetes (PWDs) on insulin therapy versus PWDs who are not on insulin therapy, controlling for social determinants.

Research design and methods: Utilizing the United States 2015 Behavioral Risk Factor Surveillance System Survey, this study used logistic regression analyses to estimate differences in self-care behaviors, healthcare provider quality of care, and diabetic complications for individuals on insulin therapy and individuals not on insulin therapy.

Results: PWDs on insulin therapy are more likely to adhere to self-care measures (self-glucose checks [OR: 7.57], self-foot checks [OR: 1.27], diabetes class participation [OR: 1.96]), adherence …

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.

Social Inclusion Outcomes For An Organization's Adolescent Parent Intervention, Anayra Ivette Tua

Walden Dissertations and Doctoral Studies

The study institution is a non-profit organization with a model developed from the continuous implementation of needs assessments of the families of adolescent parents in Puerto Rico, with the purpose of increasing their social inclusion potential. Addressing social exclusion and stigmatization of adolescent parents is vital because it generates a dual benefit for social interactions and growth. The social inclusion concept used and further elaborated for adolescent mothers is described by researchers as the level of access to engaging with institutions and societal relationships. This program evaluation was developed to understand the outcomes and effectiveness of the organization's social inclusion …

Factors Influencing Alzheimer's Disease Healthcare Utilization Patterns In Puerto Rico, Carlamarie Noboa

Walden Dissertations and Doctoral Studies

Alzheimer's disease (AD) is associated with substantial healthcare utilization costs, resulting in a public health priority. In this study, the relationship between the demographic characteristics of age, gender, and type of health insurance; the presence of comorbidities of older Puerto Rican residents diagnosed with AD; and their healthcare utilization patterns (i.e., medical office and emergency room visits and hospital admissions) was examined using Andersen's behavioral model. Data from the 2013 Puerto Rico Health Study was used in this retrospective cohort design study. All AD cases aged -?¥ 60 years were extracted using systematic random sampling. One-way ANOVA-WELCH, Mann-Whitney U test, …

Time Banks As Aging-In-Place Initiatives, Calli Sajnani

Walden Dissertations and Doctoral Studies

There has been growing concern over how state and federal governments can support the increasing population of aging Americans and their need for long-term care. Current insurance funding models cover acute hospitalization and skilled care only, leaving unskilled care needs and homemaker services at the full expense of those in need. Time banking allows individuals to exchange or barter time for goods or services without monetary payment. There is insufficient evidence to determine if members believe time banks to be a viable alternative to support aging-in-place care needs. This phenomenological study explored time banking as a potential vehicle for nonskilled …

The Hold Me Tight Program For Couples Becoming Parents: A Mixed Methods Study, Debbie Wang

Theses and Dissertations (Comprehensive)

ABSTRACT

Attachment theory has made substantial contributions to the understanding of close relationships. The purpose of this study was to inquire whether an attachment-informed psychoeducational program is a feasible and effective intervention for couples expecting their first child. The overarching question was: Is an attachment-informed relationship enhancement program, such as Hold Me Tight^® (HMT), helpful to couples in strengthening their relationship and increasing their confidence in becoming first-time parents? The research question was addressed using a mixed-methods approach.

In the first phase, the Hold Me Tight^® program developed by Dr. Sue Johnson was modified for use with couples …

Canines For Disabled Kids, Erin Jerrett, Margarita Mnatsakanyan, Colleen Reynolds, Yin Wang

School of Professional Studies

Canines for Disabled Kids have been working on behalf of children and their families to educate communities and promote service dog partnerships for almost twenty years. Their advocacy with local legislatures, business owners, and community leaders highlighted the difficulties encountered when differentiating service dogs from emotional support/comfort dogs. Service dogs are entitled to access by the Americans with Disabilities Act (ADA), while emotional support/comfort dogs are not protected under the federal statute or to the same rights. Canines for Disabled Kids proposed a study to obtain a current count of licensed service dogs in the Commonwealth and investigate the feasibility …

Pololeo Y Protección: Las Barreras De Acceso A Métodos Anticonceptivos Para Adolescentes Vulnerables En La Comuna De Macul, Santiago De Chile / Pololeo Y Protección: Barriers To Access Contraceptive Methods For Vulnerable Adolescents In The District Of Macul, Santiago De Chile, Louisa Boswell

Independent Study Project (ISP) Collection

El embarazo adolescente sigue siendo un problema de salud pública al nivel nacional en Chile. Aunque por ley, todos tienen el derecho a una educación sexual y a elegir un método de control de fecundidad, todavía existen casos de embarazos no planificados, particularmente entre adolescentes. Este estudio investigó las barreras que limitan el acceso a métodos anticonceptivos para adolescentes, enfocando primariamente en el sistema público en la Región Metropolitana. Específicamente, la investigación consideró las adolescentes de la comuna de Macul, utilizando muestras de un colegio local y dos centros de salud familiar para hacer conclusiones. La investigadora entrevistó a matronas …

When Knowledge Flows: A Case Study Of Village Health Workers’ Motivations In Jamkhed, Selaem Hadera

Independent Study Project (ISP) Collection

Across the field of global health, there have been many attempts to cater to the health needs of the most marginalized populations. Community health workers (CHWs) are individuals that live in the communities they serve and are typically low-­‐income women with little to no formal education. After a period of training by their program, they enter their communities equipped as a bridge between the community and the health system. Although CHWs do play a substantial role in health delivery and education, the structure of CHW programs varies widely, but a common characteristic of these programs is that the CHWs are …

Sex Work And Compromised Health: Health Conditions And The Barriers To Accessing Treatment Services In Pelourinho, Salvador, Amelia Fox

Independent Study Project (ISP) Collection

Sex workers remain one of the most marginalized populations in Brazilian society, both coming from and living within realities defined by poverty and poor health. Through partnership with Força Feminina – an organization located in Salvador, dedicated to aiding local sex workers– I explored the day-to-day health complications sex workers encounter and the impact these problems have on quality of life. I then questioned how discrimination and stigma impact a woman’s willingness to prioritize her health and seek out healthcare services. To pursue these questions, I utilized participant observation, interviews with 4 staff members – a pastoral educator, financial coordinator, …

Tibetan Women’S Experiences With Childbirth: A Comparative Study Of Present-Day Shangri-La And Previous Studies In Tibetan Communities, Billie Dunn-Mcmartin

Independent Study Project (ISP) Collection

What are the experiences of Tibetan women living in and around Shangri-La with pregnancy, childbirth, and motherhood? In order to explore this topic, one must first understand the context in which this topic exists: Tibetan Buddhism and culture. This paper gives a short background on women and the female body in Tibetan Buddhism, the Tibetan Medical system, and the current accessibility and regulation of hospitals, before entering into the topic of Tibetan women’s experiences with childbirth. The experiences and traditional practices of childbirth are important, as birth is universally significant as well as particularly religiously significant in Tibetan Buddhism, and …

Caring For Caregivers: Challenges Facing Informal Palliative Caregivers In Western Kenya, Hartlee Johnston

Independent Study Project (ISP) Collection

Chronic illnesses like cancer, HIV, and other non-communicable disease are increasing globally, especially in developing countries, necessitating development of palliative care and symptom management systems. In Kenya, the burden of care for chronically ill patients often falls to unpaid, informal caregivers like family members or friends. Thirty-five current or past informal caregivers from Kisumu, Kenya were interviewed about their experience, challenges they faced, and interventions they felt would be helpful. Major challenges identified included lack of finances for treatment and other living expenses; inadequate, unaffordable, or interrupted medical care; emotional stress exacerbated by juggling many responsibilities, pressure to emotionally support …

Hiv Harm Reduction Methods: A Comparison Between Switzerland And The United States, Erin Major

Independent Study Project (ISP) Collection

This paper explores the connections between harm reduction methods and the prevalence of HIV/AIDS in Switzerland and the United States of America, focusing primarily on the harm reduction methods of needle exchange programs, safe drug consumption spaces, and sex education. While these two countries are largely similar in their culture and geopolitical approaches, there are some key differences in how HIV is approached in each. Switzerland’s somewhat unique approach with relaxed drug policies and more pragmatic, harm reduction based response to the AIDS epidemic sets a model framework for other countries to follow, with comparatively widespread use of needle exchange …

When The Health System Fails You: Maternal Care Under Kenya’S 2017 Nurses' Strike, Tessa Coughtrey-Davenport

Independent Study Project (ISP) Collection

This study focuses on the 2017 nurses’ strike and how the crippling of the public health system impacted maternal care in Kisumu, Kenya. Kenya has one of the highest maternal mortality ratios in the world, and there have been many efforts to reduce this, such as delivery with a Skilled Birth Attendant and attending antenatal care visits, all of which are centered around a functioning health system. The research team used a combination of interviews with key populations and analysis of service delivery data at local health centers to evaluate the effects of the strike on maternal care. The study …

Las Condiciones De Vida De Los Usuarios Adultos Mayores Del Hospital Makewe / The Living Conditions Of Elderly Users Of Makewe Hospital, Taylor Selembo

Independent Study Project (ISP) Collection

Life conditions are a fundamental aspect of the health of senior citizens, as these are the factors that determine their quality of life and capacity to satisfy their needs. Life conditions are dependent on the particular social, political, economic, and geographic context of the region. This study intends to answer the following question: How are the life conditions of senior citizens belonging to Hospital Makewe, located in the IX region of Chile? This quali-quantitative study utilized observation, surveys (n = 40) and interviews (n = 15) in order to accomplish the main objective. The main objective was to describe senior …

Una Investigación Sobre La Prevalencia De La Lactancia Materna / 62/5000 An Investigation On The Prevalence Of Breastfeeding, Madeline Ferone

Independent Study Project (ISP) Collection

El propósito de la investigación es estudiar la realidad de las prácticas y la prevalencia de la lactancia materna en Chile, y cómo las características demográficas distintas de las mujeres influyen en la alimentación de sus bebés. La lactancia materna es crucial para el crecimiento y desarrollo saludable de un bebé, y también tiene beneficios para la salud de la madre. Sin embargo, las madres a menudo no siguen las pautas de la Organización Mundial de Salud y UNICEF. Los métodos de recolección de datos son una revisión de una Encuesta del Ministerio de Salud de 2013 de 9604 madres …

The Perceived Mental Health Effects Of China’S One-Child Policy, Avery Rasmussen

Independent Study Project (ISP) Collection

This study looked at the perceived impacts of China’s 30 year One-Child Policy (OCP). Previous studies suggested the OCP affected Chinese culture and society in a number of ways, however no studies (to the knowledge of the principal investigator) had looked at perceptions of the effects of the OCP on anxiety levels and other mental health issues of students in China. This study sought to fill the aforementioned knowledge gap and aimed to determine perceptions about the mental health effects of the OCP on students. Specifically, this study endeavored to gain a better understanding of perceptions of the effects of …

Marketing Strategy Of School Of Professional Studies In China, Jiahui Liu, Jing Wang, Shuo An, Wengxing Wang, Yiwei Wang

School of Professional Studies

Chinese students are the most visible international presence at many universities across the United States, and the number continues to grow. Since 2010, The number of graduate students studying abroad has entered the period in which the increase has been declining. Under the circumstance of the weak global economy and high cost of education, the administration needs to attract the attention of Chinese students. In the process of competing for applicants, how to develop marketing strategies to attract students’ eyeballs has become an important means of trying to increase school income through Chinese students. The marketing strategy mentioned in this …

Providers Perspectives On Self-Regulation Impact Their Use Of Responsive Feeding Practices In Child Care, Dipti A. Dev, Katherine E. Speirs, Natalie A. Williams, Samantha Ramsay, Brent A. Mcbride, Holly Hatton-Bowers

Department of Child, Youth, and Family Studies: Faculty Publications

Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's selfregulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2–5 years). Individual semistructured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare …