Public Health Commons^™

Increasing Access To Reproductive Health Care Through Improved Service Delivery, Gul Rashida, Iram Kamran, Muhammad Khalil, Zeba Tasneem, Rehan M. Niazi, Mumraiz Khan, Tahira Parveen

Reproductive Health

The study documented in this report examines the provision and utilization of public and private sector maternal and child health services in Punjab, Pakistan with a focus on family planning (FP) services. It is aimed at enabling a better understanding of the specific demand and supply dynamics leading to low contraceptive prevalence despite unmet need, and the opportunities that must be seized to enhance access to quality family planning services. The report is part of a larger project being implemented by the Population Council with the assistance of the Department for International Development, UK entitled “Sustaining Focus on Provincial Governments …

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 …

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, …

Life-Saving Medicines And Equipment In Facilities In Bangladesh, Kanij Sultana, Amy Dempsey

Reproductive Health

This research brief is a part of a larger landscaping analysis by Population Council, with support from USAID and the MacArthur Foundation. In Bangladesh, in 12 upazilas in four districts, it assessed the capacity of primary health facilities to manage pre-eclampsia and eclampsia (PE/E). This brief shares findings from 134 facilities on required infrastructure for providing maternal and newborn health (MNH) services, human resources, facility readiness, and MNH commodities and supplies. Facility readiness is vital to providing quality services to antenatal care (ANC) patients, especially to women with PE/E. Without functioning equipment, ANC/PNC registers, essential medicines, electricity, and running water, …

Married Young Women And Girls' Family Planning And Maternal Heath Preferences And Use In Ethiopia, Aparna Jain, Elizabeth Tobey, Hussein Ismail, Annabel Erulkar

Reproductive Health

Married young women and girls are the primary users of youth-centered sexual and reproductive health services in Ethiopia and, given the health risks associated with early and closely-spaced pregnancies, represent an especially important population to reach with sexual and reproductive health services. This brief looks specifically at the needs and preferences for family planning and reproductive health services among married young women and girls, with recommendations for how to more effectively ensure that they have access to those services.

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 …

Policies For Pre-Eclampsia And Eclampsia Prevention And Management In Bangladesh, Kanij Sultana, Amy Dempsey

Reproductive Health

Bangladesh experiences between 5,000 and 6,000 maternal deaths each year. Of those deaths, 20 percent are from pre-eclampsia and eclampsia (PE/E), the second most common direct cause of maternal mortality in the country. In Bangladesh, best practices to prevent PE/E using aspirin and calcium and managing it through task sharing and use of magnesium sulphate and anti-hypertensive drugs have not been optimally examined. To appreciate the enormity of the problem, the Population Council conducted a landscape analysis in 12 upazilas in four districts. The study was cross sectional, and data collection activities included in-depth interviews (IDIs) with policymakers, development partners, …

Quality Of Care In The Context Of Rights-Based Family Planning, Anrudh K. Jain

Reproductive Health

Over the past two decades, the quality-of-care framework has become a cornerstone of family planning (FP) programming. FP programs have been concerned about improving access and reducing the cost to the client but at the same time making services sustainable and improving their effectiveness and efficiency. Nevertheless, access to FP services is not equitable: educated, wealthier, or urban women have better access to the available services from a range of sources than their more vulnerable counterparts, who are less educated, poor, or live in rural areas. This policy brief suggests five modifications to the QoC framework, based on the comparison …

Rapid Evidence Assessment: Quality Of Studies Assessing Interventions To Support Fgm/C Abandonment, Tammary Esho, Jamlick Karumbi, Carolyne Njue

Reproductive Health

The last decade has seen increased focus and investment in interventions to eliminate female genital mutilation/cutting (FGM/C), along with the need to accelerate its abandonment. The UK Department for International Development (DFID) commissioned the Evidence to End FGM/C: Research to Help Girls and Women Thrive project to: 1) assess the quality of studies that have evaluated different interventions for the prevention of FGM/C, and 2) describe the FGM/C interventions that were evaluated by high-quality studies. The quality of evidence on the effectiveness and impact of FGM/C interventions is generally moderate to low. In addition, few baseline surveys are conducted prior …

Reducing Barriers To Accessing Fistula Repair: Establishing A Baseline In Ebonyi, 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 Ebonyi 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 Ebonyi. Not only do primary healthcare providers lack adequate knowledge of fistula, referral, and …

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 …

Reducing Barriers To Accessing Fistula Repair: Establishing A Baseline In Uganda, 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 Uganda 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 Uganda. Not only do primary healthcare providers lack adequate knowledge of fistula, referral, and counseling, but …

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 …

Results From Systematic Literature Review On Pe/E 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 death from 550 per 100,000 live births in 1990, to 170 maternal deaths per 100,000 live births in 2015. Despite this progress, there are still between 5,000 and 6,000 maternal deaths every year in Bangladesh, where 20 percent are the result of pre-eclampsia and eclampsia (PE/E). This systematic review of peer-reviewed literature published between January 2000 and July 2016 identified interventions adopted to manage PE/E throughout Bangladesh. Specifically, it looked at issues around quality of care, gaps in the evidence, and barriers to …

Results From Systematic Literature Review On Pe/E In Nigeria, Amy Dempsey, Karen Kirk

Reproductive Health

Pre-eclampsia and eclampsia (PE/E), hypertensive disorders of pregnancy, are consistently cited as a leading cause of maternal and newborn morbidity and mortality in Nigeria. A recent, nationwide cross-sectional survey found that PE/E contributes to 28.2 percent of national maternal deaths. The other main contributors to maternal mortality are hemorrhage and pregnancy-related infection or sepsis. To fully understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E, the Ending Eclampsia project conducted a systematic review of papers on PE/E in Nigeria published between 2000–15. The methods, results, and recommendations are discussed in this brief.

Workplace Health And The Garment Sector In Cambodia, Bunmey Yat, Carolyn Rodehau, David Wofford, Ashish Bajracharya

Reproductive Health

In Cambodia, there has been considerable investment in improving the well-being of factory workers. Understanding the key stakeholders and their roles in improving worker health is essential for policy change and ensuring that interventions achieve sustainable, long-term impact in and around the workplace. This policy brief presents selected findings from a stakeholder and situational analysis undertaken by the Cambodia Worker Health Coalition (WorkerHealth) to understand the stakeholder landscape and policy environment for women’s health in the garment industry in Cambodia, with the objective of identifying leading stakeholders and their relationships, as well as strategies and opportunities for collaboration. Collaboration and …

Uganda Retail Audit: Analysis And Report, The Evidence Project

Reproductive Health

This brief presents results of a retail audit, carried out in January 2016, that was commissioned as part of PATH’s work under the USAID-funded Evidence Project to conduct a landscape assessment of the feasibility of a Total Market Approach (TMA) in Uganda. This project also involved key informant interviews with stakeholders on their attitudes toward TMA principles and the collection of a Uganda Market Research Summary of existing family planning knowledge. The approach is based on an understanding that equitably meeting the diverse needs of different population segments requires increased coordination across sectors, including the public, private for-profit, and not-for-profit …

"You're Doing Fine, Right?": Adolescent Siblings Of Substance Abusers, Cynthia E. Clarfield

Antioch University Dissertations & Theses

There has been a rising interest in addiction medicine and addiction treatment in both the medical and behavioral health science fields. Research suggests having a family member with a substance abuse problem has negative impacts on both physical and mental health (Orford, Copello, Velleman, & Templeton, 2010a). Despite advances toward understanding the experiences of family members affected by a loved one's addiction, the siblings of substance abusers have been largely excluded from scientific research and literature. As a result, little is known about how siblings experience the impacts of a brother or sister's addiction; even less is known about the …

Improving Fall Prevention Strategies In An Acute-Care Setting, Sylvia B. Boye-Doe

Walden Dissertations and Doctoral Studies

Falls with or without injuries among the elderly have become a public health concern, with falls among adults age 65 years and older increasing every year. Nurses play a role in ensuring patient safety by following fall prevention guidelines. The purpose of this evidence-based study was to implement the RE-AIM evaluation tool to determine the impact of the Safe Five program on staff compliance with the program; patients' awareness of the need for falls prevention; and falls among older adults, ages 65 years and older, admitted to an acute care nursing unit. The literature supports implementing a falls prevention program …

Engaging Parents To Promote Children’S Nutrition And Health: Providers’ Barriers And Strategies In Head Start And Child Care Centers, Dipti A. Dev, Courtney Byrd-Williams, Samantha Ramsay, Brent A. Mcbride, Deepa Srivastava, Ashleigh L. Murriel, Chrisa Arcan, Anna M. Adachi-Mejia

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

Purpose: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers’ (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children’s health.

Design: Qualitative.

Setting: State-licensed center-based childcare programs.

Participants: Full-time childcare providers (n ¼ 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience.

Methods: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted.

Results: Two overarching themes were barriers and …

Measuring Gender Equality In Education: Lessons From 43 Countries, Stephanie Psaki, Katharine Mccarthy, Barbara Mensch

Poverty, Gender, and Youth

Through the 2015 Sustainable Development Goals (SDG), governments committed to achieving universal secondary school completion, including eliminating gender disparities, by 2030. The period from 1997 to 2014 saw considerable progress in closing gender gaps in school enrollment and attainment in many, but not all, low- and middle-income countries. However, as this research brief explains, claims that gender parity in primary education now exists are premature, especially in the poorest countries and new gender gaps, or gender-related challenges, may emerge as attainment increases. Moreover, the extremely low levels of secondary school enrollment—and even moreso completion—demonstrate that the SDG target of universal …

Effect Of Intimate Partner Violence On Children Of Puerto Rican Women, Maria Natal-Gopin

Walden Dissertations and Doctoral Studies

Intimate partner violence [IPV] is a preventable and costly societal issue that has reached epidemic proportions. Women are often the victims of IPV, and millions of children are exposed to it annually. The purpose of this study was to explore experiences of Puerto Rican mothers and their perceptions of how IPV exposure may have impacted their children using resilience theory. Data were collected via audiotaped individual interviews with 9 Puerto Rican mothers who endured an array of escalating IPV, often exacerbated by the perpetrators use of alcohol or drugs, and had IPV-exposed children aged 6 -11 years. Data analysis integrated …

When ‘Places’ Include Pets: Broadening The Scope Of Relational Approaches To Promoting Aging-In-Place, Ann M. Toohey, Jennifer A. Hewson, Cindy L. Adams, Melanie J. Rock

The Journal of Sociology & Social Welfare

Aging-in-place is a well-established concept, but discussions rarely consider that many older adults live with pets. In a ‘pet-friendly’ city, we conducted semi-structured interviews to explore perspectives of community-based social support agencies that promote aging-in-place, and those of animal welfare agencies. Applying a relational ecology theoretical framework, we found that pets may contribute to feeling socially- situated, yet may also exacerbate constraints on autonomy experienced by some older adults. Pet-related considerations at times led to discretionary acts of more-than-human solidarity, but also created paradoxical situations for service-providers, impacting their efforts to assist older adults. A shortage of pet-friendly affordable housing …

The Transition Experiences Of International Graduate Students In Clark University School Of Professional Studies, Xuesong Huang, Mingyang Lian, Dang Trung, Jay Sheth, Yuwei Yang, Irina Klimenko

School of Professional Studies

In the last decade, the School of Professional Studies at Clark University has witnessed a sharp increase in international students. More and more international students in the millennial generation have entered the School of Professional Studies pursuing one of the two-year graduate programs: Master of Science in Professional Studies, Master of Science in Public Administration, and Master of Science in Information Technology. In the past, working adult student dominant the program. These students already had a career outside the classrooms before them came to study. The millennial international students have generated new adjustment problems. Some of the transition issues of …

Breast Is Best: Determinants Of Breastfeeding In Bali, Leah Hardenbergh

Independent Study Project (ISP) Collection

Breastfeeding greatly benefits the health of newborns, providing them with needed antibodies and protection from numerous diseases, including some of the leading causes of infant mortality. This paper explores breastfeeding practices in Bali, and the wide array of factors that have led to these practices. After discussing how breastfeeding fits into the larger context of maternal and newborn health, I explain factors in Bali that affect a woman’s decision to breastfeed and experience while breastfeeding. Determinants include those related to health, financial position, and social status. I explore the history of formula companies and formula as an alternative to breastmilk, …

Sugar And Spice, Not Everything's Nice: Changing Dietary Habits In Bali, Harry Teplow

Independent Study Project (ISP) Collection

In this paper, I will explore the ways in which locals interact with new food options on the island of Bali. Specifically, I will explore dietary behaviors surrounding pre-­‐ packaged snacks and ‘fast-­‐food’ chains and determine whether the presence of these food options is affecting the Balinese’s relationship with more traditional cuisine. I will use everyday observations and conversations with locals to analyze dietary habits and the various food items that are being consumed while examining the potential dietary differentiation between two age groups. I will also consider health outcomes in Bali and discuss how changing dietary habits may be …

Consecuencias De La Dictadura: La Salud Mental Transgeneracional En Hijos De Detenidos Desaparecidos / Consequences Of The Dictatorship: Transgenerational Mental Health In Children Of Disappeared Detainees, Catherine Sillari

Independent Study Project (ISP) Collection

Research Question: What are the trends seen in the mental health of the children of the people who were “disappeared” by the Pinochet dictatorship?

Objectives: The general objective of this study is to look for trends in the mental health of children of disappeared people. The specific objectives are to understand the particular stresses that come with disappearances versus other types of deaths, to gage the general opinion of the government’s system of reparation, and to identify common coping methods.

Background: Between the years of 1973-1990, Chile was under the military dictatorship of Augusto Pinochet. During this time, major …

“Always A Double-Edged Sword”: How Women And Health Care Providers Navigate Issues Of Contraception In Differing Senegalese Communities, Angelina Strohbach

Independent Study Project (ISP) Collection

This paper examines how women and health care providers in two distinct Senegalese settings—Dakar and Mouit, a village located within the Gandiol region-- navigate contraception as both a social and medical good. Contraception is an invaluable tool in terms of advancing women’s right to reproductive health, but major discrepancies in its usage exist across a variety of social lines in Senegal, including level of education, marital status, occupation, age, and living in a rural versus urban setting. What socially constructed thought processes and lived experiences contribute to these discrepancies? In a cultural context heavily based upon tradition and Islamic faith, …

Immunomodulators As Therapeutic Agents In Mitigating The Progression Of Parkinson's Disease, Bethany Grimmig, Josh Morganti, Kevin Nash, Paula C. Bickford

Sanders-Brown Center on Aging Faculty Publications

Parkinson’s disease (PD) is a common neurodegenerative disorder that primarily afflicts the elderly. It is characterized by motor dysfunction due to extensive neuron loss in the substantia nigra pars compacta. There are multiple biological processes that are negatively impacted during the pathogenesis of PD, and are implicated in the cell death in this region. Neuroinflammation is evidently involved in PD pathology and mitigating the inflammatory cascade has been a therapeutic strategy. Age is the number one risk factor for PD and thus needs to be considered in the context of disease pathology. Here, we discuss the role of neuroinflammation within …

“It’S Not Important For You To Speak:” The Perception Of Purity And Its Power Over Women’S Reproductive And Sexual Health, Margot Radding

Independent Study Project (ISP) Collection

There is a general silence in both society and academia surrounding women’s health and the social conception of purity. Purity myths and misconceptions have created stigmas that women of all backgrounds must navigate to manage and care for their reproductive and sexual health. This study investigates the importance of purity and how it is used to define, measure, and categorize women’s bodies and behaviors. Women’s perception of purity, specifically in regards to menstruation and pre-marital sex, were investigated using semi-structured interviews in Dehradun, Uttarkhand. This study analyzes how stigmatized conceptions of impurities manifest as silence in society. Data collected from …