Public Health Commons^™

National Efforts Toward Fgm-Free Villages In Egypt: The Evidence Of Impact, Ghada Barsoum, Nadia Rifaat, Omaima El-Gibaly, Nihal Elwan, Natalie Forcier

Poverty, Gender, and Youth

This report is a midterm evaluation and documentation of the process and approach of the FGM-Free Village Model implemented in Egypt by the National Council of Childhood and Motherhood with assistance from the Population Council. In a comparison of responses from women and men in intervention groups to those in nonintervention (control) villages, data analysis shows that the program has been successful in changing views and attitudes toward female genital mutilation (FGM). FGM is an entrenched generational practice, and eradicating it in a community requires concerted effort over an extended period of time. This evaluation strongly recommends that efforts be …

Innovative Financing Through Pay-For-Performance For Providers To Improve Quality Of Care In Bangladesh: Transforming Research Into Action, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena

Reproductive Health

To improve access to and use of facility-based obstetric and newborn care, the Government of Bangladesh is implementing two innovative performance-based financing programs, namely demand-side financing (DSF) and pay-for-performance (P4P). With the purpose of identifying the lessons learned, limitations of the P4P and DSF models, and scopes for cross learning, a two-day workshop was organized in Dhaka. This workshop report, prepared by the Population Council, resulted in several recommendations to modify DSF and P4P schemes. In Bangladesh, the need for continuing performance-based financing programs to meet MDGs and other health indicators is beyond argument, but it is urgently required to …

Using Evidence To Improve Primary Health Care In Thai Nguyen Province, Population Council

Reproductive Health

In partnership with a number of local stakeholders, the Population Council Viet Nam is working to improve the evidence base available to health authorities and to use that evidence to improve health in Thai Nguyen Province. Building on cooperation between the Population Council and the Thai Nguyen Health Department, the project detailed in this report has three main elements: 1) developing a computerized information system to generate regular reports; 2) supporting research in the province to better understand health problems, health-seeking behavior, and health services; and 3) increasing the capability of managers and providers to better use the evidence generated. …

Shaping Demand And Practices To Improve Family Health Outcomes In Northern India: A Framework For Behavior Change Communication, Population Council

Reproductive Health

An initiative from the Population Council could help in developing a comprehensive communication strategy to improve reproductive, maternal, newborn, and child health, and nutrition outcomes in Uttar Pradesh and other northern states of India. The identification of key barriers to and facilitating factors for selected target behaviors that have a direct bearing on maternal and child health could go a long way in packaging specific messages for different stakeholders, such as women, husbands, elder family members, opinion makers in the community, and frontline health workers. One of the key deliverables of this publication is to fill an important knowledge gap …

Increasing Access To Safe Abortion In Rural Maharashtra: Outcomes Of A Comprehensive Abortion Care Model, Shireen J. Jejeebhoy, A.J. Francis Zavier, Rajib Acharya, Shveta Kalyanwala

Reproductive Health

This assessment of a Comprehensive Abortion Care (CAC) model was conducted by the Population Council on behalf of the Consortium for Safe Abortions in India. The goal of the Consortium is to increase access to legal, safe, and comprehensive abortion services, including post-abortion family planning, in the public health system, and especially among the rural poor. This report describes the CAC model implemented in Aurangabad district, Maharashtra, and examines the extent to which the model improved (a) the availability and quality of abortion services in public sector facilities, and (b) women’s awareness and experiences with regard to abortion services. It …

Increasing Access To Safe Abortion In Rural Rajasthan: Outcomes Of A Comprehensive Abortion Care Model, Shireen J. Jejeebhoy, A.J. Francis Zavier, Rajib Acharya, Shveta Kalyanwala

Reproductive Health

This report describes an assessment by the Population Council of the Comprehensive Abortion Care (CAC) model implemented in Tonk district, Rajasthan. Findings highlight that at the time of the baseline survey, the availability of abortion services was limited; also evident was the poor quality of abortion-related care. Given this context, and given the short duration of implementation, the changes achieved by the intervention are promising. The district-level CAC model succeeded in strengthening facilities, training providers, and increasing women’s access to safe abortion services at the Primary Health Centre level. Community-level activities were less successful, attributable to a considerable extent to …

Expanding Access To Safe Abortion And Post-Abortion Care: Recommendations Of A South Asia Regional Consultation, Population Council

Reproductive Health

A South Asia Regional Consultation, organized by the Population Council with representation from governments and key stakeholders of Bangladesh, India, Nepal, and Pakistan, was held in New Delhi, to discuss ways of expanding women’s access to safe abortion services. The Consultation deliberated on ways of expanding the provider base for safe induced abortion so as to overcome inadequate and inequitable access to safe abortion. They also looked to expand access to services for the management of incomplete abortion and complications of unsafe abortion that persist in the region and, thereby, to reduce morbidity and mortality resulting from unsafe abortion. In …

Introduction Of Medical Abortion In Ghana, Emmanuel Kuffour, Selina F. Esantsi, Placide Tapsoba, Gloria Quansah Asare, Ian Askew

Reproductive Health

To significantly expand women’s access to modern family planning and comprehensive abortion care services a provisional license was awarded to Marie Stopes International-Ghana by the Ghana Food and Drugs Board for the introduction and provision of the first medical abortion regimen (mifepristone and misoprostol) in Ghana. The Population Council conducted this study to document the introduction process; findings from the study will provide much needed evidence to inform policy decisionmaking and the scale-up phase. Overall the study has shown that medical abortion is a viable option for Ghanaian women--an overwhelming number of those who have benefitted from the procedure are …

Female Genital Mutilation Practices In Kenya: The Role Of Alternative Rites Of Passage. A Case Study Of Kisii And Kuria Districts, Habil Oloo, Monica Wanjiru, Katy Newell-Jones

Reproductive Health

This research was undertaken by the Population Council to better understand female genital mutilation (FGM) as currently practiced by the Kuria and Kisii communities in Kenya. The study investigated current attitudes and practices in relation to FGM, awareness and attitudes toward the alternative rite of passage (ARP), and factors which encourage individuals to make decisions to abandon FGM. The findings show that FGM is still a celebrated public event among the Kuria, whereas in Kisii, it is a private family affair. The study suggests that the success of ARP as an approach to abandoning FGM is strongly dependent on the …

Using Community Health Workers Can Lead To Positive Sexual Behavior Outcomes Among People Living With Hiv, Population Council

Reproductive Health

This operations research summary reports on the use of community health workers (CHWs) in Kenya to influence sexual behavior outcomes of people living with HIV/AIDS. Results of the Population Council’s APHIA II project indicate that using community-based health workers to provide information and counsel people living with HIV as well as make referrals for antiretroviral therapy can lead to increased uptake of ART among those eligible but not on treatment, and to positive sexual behavior outcomes. HIV prevention and care programs should therefore work with CHWs to increase the reach and impact of their activities.

Comprehensive Responses To Sexual Violence In East And Southern Africa: Lessons Learned From Implementation, Jill Keesbury, Ian Askew, Monica Wanjiru, Grace Chiyaba, Kate Wilson, Felly Nkweto Simmonds

Reproductive Health

The Population Council has provided technical assistance and conducted research to strengthen the evidence base on sexual and gender-based violence (SGBV) programming in sub-Saharan Africa, where countries have begun to recognize the importance of both preventing violence and responding to the needs of SGBV survivors. These activities have created an active network of partners from across sub-Saharan Africa, who are developing, implementing, and evaluating core elements of a comprehensive, multisectoral response model. This brief reports how network partners have significantly increased the evidence base on program responses: a range of successful approaches have been demonstrated for improving comprehensive services within …

Scaling Up The Provision Of Family Planning Messages In Antenatal And Postpartum Services In Upper Egypt, Nahla G. Abdel-Tawab, Sally Saher

Reproductive Health

An operations research study by the Population Council’s FRONTIERS program in 20 facilities in Upper Egypt showed that integration of birth spacing messages into antenatal and postpartum care was feasible, acceptable to women and their husbands, and was associated with increased postpartum contraception. This report describes the initial and scale-up phases, their outcomes, challenges, and recommendations for improvement. In addition to successfully scaling up the program, the main achievement was securing the support and investment of senior MoHP officials at the central level, as well as the support and commitment of managers and supervisors at governorate and district levels. The …

The Prevention And Management Of Hiv And Sexual And Gender-Based Violence: Responding To The Needs Of Survivors And Those-At-Risk, Sarah Raifman, Ian Askew, Sajeda Amin, Jill Keesbury, Saiqa Mullick, Judith A. Diers, Meiwita P. Budiharsana, Chi-Chi Undie, Mary Zama, Mantshi Menziwa, Sherry Hutchinson, Naomi Rutenberg

Reproductive Health

The Population Council seeks to understand the social, economic, political, and physical context of risks for sexual and gender-based violence and HIV. Among the top priorities of Council research are supporting and evaluating efforts to prevent violence and HIV, including creating safe spaces for adolescent girls, and working with men and boys to change gender norms within the community; and comprehensively responding to the needs of survivors (including those who are HIV-infected) by strengthening health systems and integrating services. The purpose of this guide is to provide practical guidance on the steps necessary to establish and strengthen sexual violence (SV) …

Ten Years Of The Kenya Adolescent Reproductive Health Project: What Has Happened?, Humphres Evelia, Monica Wanjiru, Francis Obare, Harriet Birungi

Reproductive Health

This evaluation by the Population Council’s APHIA II Operations Research Project sought to find out whether the adolescent sexual and reproductive health (ASRH) and HIV/AIDS activities in Kenya had been sustained over a 10-year period when the project was replicated and scaled up to cover seven provinces in the country. The evaluation had three main objectives: 1) to determine the extent to which activities of the Kenya Adolescent Reproductive Health Program (KARHP) have continued at national, provincial, and district levels; 2) to determine whether desired sexual and reproductive health outcomes (knowledge, behavior, and practices) have been sustained among in- and …

A Concept Mapping Needs Assessment Of Young Families With Parental Cancer, Richard P. Durant

Antioch University Dissertations & Theses

The purpose of this research is to investigate the support needs of young families living with and beyond a parental diagnosis of cancer. The sample includes 56 participants comprised of 31 professional stakeholders and 25 patient stakeholders affiliated with the Charles R. Wood Cancer Center. It was hypothesized there would be differences in how the groups of stakeholders rated needs in terms of importance, satisfaction, and utilization. Differences in ratings are thought to be barriers to effective program development. While not a formal research hypothesis, it was anticipated other program development barriers germane to naturalistic clinical settings would emerge from …

Using Youth-Friendly Communication Approaches To Communicate Hiv/Aids With Young People Is Feasible And Acceptable, Population Council

Reproductive Health

HIV remains a major concern in Kenya among all segments of the population, including adolescents. New ways of delivering HIV information and services are therefore needed, especially to reach young people and encourage them to take up counselling and testing to know their sero-status. The APHIA II Operations Research Project collaborated with the Ministry of Education, Well Told Story, and the National AIDS and STD Control Programme to implement a project to enhance communication in schools about HIV and create demand for early counseling and testing. The project also sought to create a supportive environment in schools for young people …

Evaluation Of Capacity For Best Practice Of Clinical Vaccine Research In Western Kenya, Sylvie Anne Kwedi

Walden Dissertations and Doctoral Studies

African institutions that perform health research need to continuously evaluate their practices in order to ensure compliance with international standards of good clinical practice (GCP). This mixed-methods study, undertaken at one clinical research site in Western Kenya, was an evaluation of GCP compliance at the site, research participants' satisfaction with research procedures, and research participants' comprehension of informed consent. The qualitative portion of the study involved audit of the site's compliance with GCP standards. The quantitative portion was an assessment of participant satisfaction and informed consent comprehension, undertaken through interviews with a sample of 297 participants. Thematic analysis of the …

Factors Associated With Tobacco Use Among Rural And Urban Pregnant Women, Whitney Jeanne Katirai

University of Kentucky Doctoral Dissertations

The purpose of this study was to investigate the influences of smoking on rural and urban pregnant women. More specifically, the variables of the knowledge of health effects, health provider recommendations, subscores from the Health Belief Model (HBM), and social support were explored in relation to the smoking behavior of pregnant women. A secondary purpose was to investigate the accuracy of self-reported smoking during pregnancy using biochemical validation. Pregnant women (N=71) completed an anonymous questionnaire, designed by the researcher, to identify variables that predicted smoking for urban and rural women. Participants also gave a saliva sample for cotinine testing.

Approximately …

Application Of The Water Poverty Index In Border Colonias Of West Texas, Marcelo Korc

Open Access Theses & Dissertations

This study applied the Water Poverty Index (WPI) in border colonias and other rural areas of west Texas. The colonias are mostly unincorporated communities located primarily in New Mexico and Texas along the border with Mexico and are characterized by high poverty rates and substandard living conditions. In Texas, access to drinking water and sanitation services has been identified as one of the most significant determinants of health in over 350 colonias with about 50 thousand residents.

The WPI is a multidimensional measure that links household welfare with water availability. WPI components were identified and prioritized by a wide range …

Development And Evaluation Of A Personalized Normative Feedback Intervention For Hispanic Youth At High Risk Of Smoking, Holly Mata

Open Access Theses & Dissertations

Despite reductions in overall smoking rates, data show that adolescents continue to smoke at higher rates than adults and that adolescents living in the Texas-Mexico border area are more likely than their counterparts living elsewhere in Texas to smoke. While adult smoking in the Paso del Norte Region has decreased significantly over the past decade, area youth smoking rates exceed both state and national averages. Recent estimates report cigarette smoking among El Paso youth in the past month to be slightly more than 28% as compared with 21% among Texas youth participating in the 2009 statewide Youth Risk Behavior Survey …

Relationships Between Central Obesity, Fructose Intake, And Non-Alcoholic Fatty Liver Disease In Overweight Hispanic Adolescents, Hector Reyes

Open Access Theses & Dissertations

Introduction: The purpose of this study was to evaluate whether central (visceral) fat measured as waist circumference and daily fructose intake were associated with measures of non-alcoholic fatty liver disease (NAFLD) in Hispanic overweight adolescents.

Methodology: Thirty four obese boys (n=15) and girls (n=19) between the ages of 13 and 18 years were measured for body composition, waist circumference, and dietary fructose intake. Fasting alanine (ALT) and aspartate (AST) aminotransferase levels in blood, ALT/AST ratio, and hepatic fat fraction (HFF) by magnetic resonance imaging were measured and used as surrogates for NAFLD. Pearson Product-Moment correlation analyses were used …

Assessment Of Intra-Urban Traffic-Related Air Pollution On Asthmatic Children's Exposure At Schools In The Paso Del Norte Region, Amit Ugamraj Raysoni

Open Access Theses & Dissertations

Traffic-related air pollution can be a major public health concern in any urban area. This problem is compounded in the Paso del Norte region that has experienced rapid economic growth, and a substantial number of people living in close vicinity of major roadways. The desert surroundings, arid weather, frequent temperature inversions, heavy border traffic at the international ports of entry between El Paso and Ciudad Juárez, and poorly maintained vehicle fleet further exacerbates this problem. A growing body of air quality and epidemiologic research has discerned the linkage between traffic emissions and respiratory disorders.

Initial health investigations in the Paso …

The Impact Of Breast Cancer Educational Workshops On Knowledge And Breast Self-Examination Practice Among Korean-American Women, Corinne Lee

Master's Theses and Doctoral Dissertations

Among Korean-American women, breast cancer is the second leading cause of death. Although their incidence is lower than that of Caucasian women, Korean-American women are more likely to be diagnosed at more advanced stages of breast cancer. One of the suggested methods in breast cancer prevention is early detection and routine screenings. The present study was conducted to explore the impact of breast cancer educational workshop on breast cancer knowledge and breast self-examination practices among Korean-American women. The knowledge of breast cancer and the health beliefs (perceived benefits, perceived barriers, and perceived self-efficacy) was examined before and after the educational …

Increasing Cervical Cancer Screening In A Hispanic Migrant Farmworker Community Through Faith-Based Clinical Outreach, John S. Luque, Dinorah Martinez-Tyson, Talar Markossian, Ji-Hyun Lee, Rachel Turner, Sara Proctor, Janelle Menard, Cathy D. Meade

Community Health: Faculty Publications

Objective: Partnerships between academic medical centers and faith-based community organizations have been associated with increased screening rates in low-income minority women. We describe clinical outcomes of an outreach partnership between a cancer center and a faith-based outreach clinic offering gynecologic screening services in central Florida to increase cervical cancer screening adherence in a priority population of primarily Hispanic farmworker women.

Methods: Data sources included a retrospective chart review. This descriptive study examined patterns of cervical cancer screening behavior among the patient population of the faith-based outreach clinic.

Results: Findings suggest that among this group of patients, the demographic factors that …

Salud Es Vida: Development Of A Cervical Cancer Education Curriculum For Promotora Outreach With Latina Farmworkers In Rural Southern Georgia, Kristen J. Wells, John S. Luque, Branko Miladinovic, Natalia Vargas, Yasmin Asvat, Richard G. Roetzheim, Ambuj Kumar

Community Health: Faculty Publications

Methods: A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (i) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (ii) were a randomized controlled trial (RCT), case-controlled study, or quasi-experimental study; and (iii) evaluated a CHW intervention outside of a hospital setting.

Results: Participation in a CHW intervention was associated with a statistically significant …

Barbershop Communications On Prostate Cancer Screening Using Barber Health Advisers, John S. Luque, Brian M. Rivers, Clement K. Gwede, Maisha Kambon, B. Lee Green, Cathy D. Meade

Community Health: Faculty Publications

Objective: The authors report the outcomes of a community-based, barber health adviser pilot intervention that aims to develop customized educational materials to promote knowledge and awareness of prostate cancer (CaP) and informed decision making about prostate cancer screening (PCS) among a predominantly African American clientele.

Method: First, the authors implemented a series of learner verification processes with barbershop clients (n=15) to adapt existing CaP health promotion materials. Following intervention implementation in the barbershop, they conducted structured surveys with barbershop clients (n=40) to evaluate the intervention. Results: Findings from the posttest showed both a significant increase in barbershop clients' …

Professional Preparation Of Secondary Health Education Teachers In Mississippi, Ensley Howell

Electronic Theses and Dissertations

The purpose of this study was to examine the professional preparation of secondary health education teachers in Mississippi. All four-year institutions of higher learning were contacted to determine the requirements for an approved program in order to obtain a supplemental endorsement in health, to compare the similarities and differences, and to determine the extent to which the approved programs reflect the ten content areas of the Mississippi Comprehensive Health Framework. This study also examined the status of secondary school health education programs in Mississippi by utilizing selected data from the U.S. Department of Health and Human Services Centers for Disease …

Care Coordination, Family-Centered Care And Functional Ability In Children With Special Health Care Needs In The United States, Madeline Marti-Morales

Walden Dissertations and Doctoral Studies

Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children's functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, …

The Experience Of Menopause As Reported By Sedentary Women, April Elizabeth Ann Rietdyk

Walden Dissertations and Doctoral Studies

Limited research exists on the experiences of sedentary women as they transition through menopause. This gap creates difficulty for public health practitioners as they strive to develop resources, implement programs, or influence policy change at the community level for this group of marginalized women. Keeping women healthy throughout the aging process, including menopause, improves their quality of life and decreases the impact aging has on the health care system. This phenomenological study, through in-depth interviews, provided the opportunity for sedentary women to share their thoughts and experiences of menopause. Thirteen sedentary women between the ages of 40 and 60, experiencing …

The Relationship Between Daily Snowfall Accumulation And Pattern And Severity Of Traumatic Injuries At A U.S. Ski Resort, S. Jason Moore

Walden Dissertations and Doctoral Studies

Throughout the relevant literature, research addressing the impact of a specific environmental factor, such as snowfall, on injury patterns or severity among alpine skiers and snowboarders is sparse. The foundation for inquiry into this relationship was developed based on principles of physics and traumatology coupled with findings in the available literature. Secondary analysis of trauma registry data coupled with daily snowfall measurements from one of the largest ski areas in North America illustrated a negative correlation between daily snowfall amount and injury severity (r = -.08). Concordant findings demonstrated an increased odds of sustaining an injury defined as severe or …