Public Health Commons^™

Pregnancy Outcomes Among Women With An Unintended Pregnancy: Findings From A Prospective Registry In Rural Pakistan, Sumera Aziz Ali, Shiyam Sunder Tikmani, Margo S. Harrison, Sarah Saleem, Robert L. Goldenberg, Elizabeth M. Mcclure, Omrana Pasha

Community Health Sciences

Background: Unintended pregnancies are an important public health issue in both developed and developing countries. An unintended pregnancy may affect maternal health seeking behavior during the antenatal and postpartum periods, which can adversely affect perinatal outcomes. Aim: The specific aim of our study was to measure antepartum, intrapartum, and postpartum pregnancy outcomes among women with unintended pregnancies in a rural Pakistani population.
Methods: Using a prospective maternal and newborn health registry in Thatta Pakistan, we evaluated temporal associations between unintended pregnancy and several dimensions of health seeking behavior including: antenatal care, preference for private versus government facility for antenatal care, …

Facilitating Factors And Barriers To Weight Management In Women: Physician Perspectives, Renee E. Walker, Jennifer Kusch, Jennifer T. Fink, David A. Nelson, George Morris Iii, Jessica Skalla, Ron A. Cisler

Journal of Patient-Centered Research and Reviews

Purpose: The complexity of addressing overweight and obesity in women has been an ongoing public health and health care challenge. While the mechanism for addressing overweight and obesity in women remains unclear, it has been speculated that disparities in overweight and obesity by race and gender contribute to the complexity. The purpose of the present study was to examine perceptions of primary care physicians when discussing weight management with their patients.

Methods: We conducted focus group discussions exploring facilitators and barriers to discussing weight management and weight loss among women patients. Participants included 18 family medicine and internal medicine physicians …

Zika, Pregnancy, And The Law, Sam F. Halabi

Arkansas Law Review

The public health emergency surrounding the spread of the Zika virus has resurrected and brought into sharp relief some of the most vexing questions surrounding the relationship between pregnancy and law: the appropriate circumstances, if any, in which fetal tissue research is permissible; when and how the government may sponsor statements intended to influence reproductive decisions; and how to balance the health and rights of both women and their unborn children when health threats target both.

The Effectiveness Of Critical Time Intervention For Abused Women Leaving Women’S Shelters: A Randomized Controlled Trial, Danielle A. M. Lako, Marielle D. Beijersbergen, Irene E. Jonker, Renee De Vet, Daniel B. Herman, Albert M. Van Hemert, Judith R. L. M. Wolf

Publications and Research

Objectives: To examine the effectiveness of critical time intervention (CTI)—an evidence-based intervention—for abused women transitioning from women’s shelters to community living. Methods A randomized controlled trial was conducted in nine women’s shelters across the Netherlands. 136 women were assigned to CTI (n = 70) or care-as-usual (n = 66). Data were analyzed using intention-to-treat three-level mixed-effects models.

Results: Women in the CTI group had significant fewer symptoms of post-traumatic stress (secondary outcome) (adjusted mean difference - 7.27, 95% CI - 14.31 to - 0.22) and a significant fourfold reduction in unmet care needs (intermediate outcome) (95% CI 0.06–0.94) compared to …

Addressing Health Disparities And Cultural Competency In Reproductive Health Through Active Learning In The University Of Puerto Rico, School Of Medicine, Ines E. Garcia-Garcia, Kary M. Bouet Md, Lourdes Garcia-Fragoso, Juan Rivera-Gonzalez

Journal of Health Disparities Research and Practice

Introduction: Lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights which impact reproductive health. Previous pregnancy, induced abortion, and hormonal contraceptive use are common among women who report sex with women, regardless of self-identification as lesbian. LGBTQ have higher risk of smoking, use illicit drugs or have alcohol related problems. Methods: A faculty development training addressed methods and skills for teaching cultural competence and eliminate health disparities. Faculty facilitated a small group active learning activity, including a vignette and a reflective self-evaluation, for medical students …

Persistence With Mammography Screening And Stage At Breast Cancer Diagnosis Among Elderly Appalachia-West Virginia Women, Ami Vyas, Suresh Madhavan, Usha Sambamoorthi

Journal of Health Disparities Research and Practice

The objective of this study is to evaluate the association between persistence with mammography screening and stage at breast cancer diagnosis in elderly Appalachia-West Virginia women diagnosed with first incident breast cancer. The study utilized West Virginia Cancer Registry-Medicare linked database to identify women age 70 and above diagnosed with first incident breast cancer in 2007. Persistence to mammography screening was defined as having had at least three mammography screenings before breast cancer diagnosis. A multiple logistic regression was conducted to assess the association between persistence with mammography screening and stage at breast cancer diagnosis in these women. Of the …

Determining The Barriers To Prenatal Care Entry Within The First Trimester By Evaluation Of Prenatal Care Surveys And Questionnaires, Joycelyn Akamune

Master of Public Health Program Student Publications

Background: Prenatal care (PNC) within the first trimester is associated with improved fetal and maternal health outcomes. Improved PNC is necessary to prevent negative birth outcomes such as low birth weight and infant mortality, which have significant impact on birth outcome rates. Improving access to PNC in the first trimester involves removing barriers to care. A brief survey distributed to expectant mothers is a simple way to define these barriers. Many small community health centers do not use surveys to gather patient information. By reaching this population, barriers to PNC can be better understood and mitigated using community resources decreasing …

Bhutan: Human Trafficking, Cindy Osagie

Global Public Health

Human trafficking has been present in Bhutan for many years but has continued to increase along Bhutan’s borders. The reason for this increase can be contributed to the rise of vulnerable citizens. In particular, women and children are extremely susceptible to forced labor and sex trafficking. This brief further details the challenges, political structure, epidemiology, and also the intervention and identification of human trafficking in Bhutan. The increase of human trafficking can also be correlated to the rise in HIV/AIDS in Bhutan. The challenges that has stopped any progress in reducing human trafficking, is the government of Bhutan’s continuous denial …

Lithuania: Cervical Cancer, Samantha Dinglasan

Global Public Health

Lithuania is an upper middle income country but is one of the poorest of the countries in the EU. This country is run by a Unitary Semi-Presidential Representative Republic and has a population of just under 3 million people. Due to the poor healthcare system and corruption, Lithuania has several different concerns for their population health and cervical cancer is one of these. This ongoing concern has been continuously growing but there are various studies that indicate a potential decrease in incidence and mortality rates caused by this disease. Vaccines, education, and general awareness has proven to make some impact …

Gender Disparities In The Association Between Socio-Demographics And Non-Communicable Disease Risk Factors Among Adults With Disabilities In Shanghai, China, Youran Zhang, Gang Chen, Qi Zhang, Jun Lu, Huijiong Yu

Community & Environmental Health Faculty Publications

BACKGROUND. Non-communicable disease (NCD) risk factors can co-exist with disability and cause a greater burden on the health status of adults with disabilities. A lack of egalitarian social policies in China may result in gender disparities in the NCD risk factors of adults with disabilities. However, little is known about the gender disparities in the association between socio-demographics and NCD risk factors among adults with disabilities in China; consequently, we examined this association among adults with disabilities in Shanghai, China.

METHODS. We used the health examination data of 44,896 adults with disabilities in Shanghai in 2014. Descriptive analyses and …

Engaging Male Partners Of Adolescent Girls And Young Women In Hiv Services In Malawi: Findings From Dreams Implementation Science Research, Project Soar

HIV and AIDS

Important contributors to adolescent girls' and young women's (AGYWs') vulnerability to HIV are the power differentials in their sexual relationships with male partners. Therefore, engaging male partners of AGYWs is important in reducing HIV incidence among these women. Project SOAR, in collaboration with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted qualitative research in the districts of Zomba and Machinga in Malawi to: 1) identify and locate the types of men who have sexual relationships with AGYW; 2) understand the challenges to and facilitators of accessing HIV services among AGYWs’ male partners; and 3) …

Modeling The Relationship Between Women’S Perceptions And Future Intention To Use Institutional Maternity Care In The Western Highlands Of Guatemala, Emily Peca, John Sandberg

Global Health Faculty Publications

Background

Despite global gains, women in hard-to-reach areas are at a relatively higher risk of death and disability related to childbirth. Traditional methods of measuring satisfaction may mask negative experiences (such as disrespect and abuse) that can drive down demand for institutional care. Better measurement of women’s perceptions of care quality, especially among marginalized populations with historically low utilization of institutional care, are needed to inform how to improve services and foster greater utilization of (potentially life-saving) clinical care.

Methods

A population-based household survey was conducted in 15 purposively selected villages in the rural Western Highlands of Guatemala among women …

Barriers To Contraceptive Use In Nicaragua, Ellen Motley

Theses and Graduate Projects

Many barriers to contraceptive use exist in sexually active Nicaraguan women, leading to increasingly high rates of unintended pregnancies among these women. Higher rates of depression, domestic abuse, and unemployment are also seen in this group of women. These women face more complications during pregnancy and receive higher rates of unsafe abortions, impacting the mom and the infant, as well as the community in which they live. Some of the barriers to contraceptive use include lack of access to healthcare, lack of knowledge about contraceptive methods, negative attitudes about contraceptives, providers’ fear of criticism, previous dissatisfaction or contraceptive failure, family …

Hpv Screening In Nicaragua, Claire Maccani

Theses and Graduate Projects

Cervical cancer is the leading cause of mortality due to a malignant neoplasm for young women in Latin America and the leading cause of cancer among women of any age in Nicaragua. Additionally, cervical cancer is the third most common cause of cancer death in females worldwide. This paper will focus on just the screening aspect of prevention. There are also vaccines now available for preventing certain oncologic strains of HPV which ultimately leads to prevention of cervical cancer. There is not yet an organized program offering HPV vaccination in Nicaragua due to the high cost of the vaccine. The …

Female Sex Workers Living With Hiv In Tanzania Have Both A Need For Contraception And A Desire To Have Children In The Future, Project Soar

HIV and AIDS

HIV-positive women often have critical family planning (FP) needs in addition to HIV-related care, treatment, and prevention concerns. In sub-Saharan Africa, unintended pregnancy is common among HIV-positive women. At the same time, many women living with HIV want to have children some day, and there are various “safer conception” strategies available to help HIV-affected individuals and couples get pregnant while minimizing the risk of HIV transmission to seronegative partners and the baby. This brief describes the fertility-related needs and desires of female sex workers living with HIV in Tanzania, highlighting results indicating that health services should help women meet both …

Male Partners Of Adolescent Girls And Young Women: Relationship Characteristics And Hiv Risk—Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

Adolescent girls and young women (AGYW) in South Africa, as in many countries, are particularly vulnerable to HIV for a variety of reasons, including economic disadvantage and unequal power dynamics in sexual relationships with their male partners—many of whom are older and engage in high-risk behaviors. In an effort to learn more about men’s relationships with AGYW and how HIV services can better engage them, the Population Council is conducting implementation science research in KwaZulu-Natal Province. This brief reports findings from a 2017 baseline survey with nearly 1,000 men. An endline survey is planned for mid-late 2018, and will focus …

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Kenya? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Kenya to build needed evidence to inform community-based, girl-centered interventions. DREAMS programs in Kenya are implementing a core package of interventions in the highest HIV-burden areas to address HIV risk among adolescent girls and young women (AGYW)—a population in which AIDS is the leading cause of death in the region. This brief summarizes key findings from a survey of 1,778 AGYW, more than half of whom are enrolled in DREAMS programming.

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Zambia? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Zambia and other countries across sub-Saharan Africa to build needed evidence to inform community-based, girl-centered HIV-prevention programming. Critical to this process is understanding adolescent girls’ and young women’s (AGYWs’) knowledge, attitudes, sexual behaviors, and characteristics of their sexual partnerships that may put them at risk of HIV acquisition. This results brief summarizes key findings from a cross-sectional survey of 1,915 AGYW, half of whom were 15–19 years old and the other half 20–24 years old, residing in urban districts of Lusaka and Ndola. The findings in this brief were shared at …

Uterine Corpus Malignancies In Appalachia Kentucky: Incidence, Survival And Related Health Disparities, Marian Symmes Johnson

Theses and Dissertations--Clinical Research Design

Uterine cancer is the nation’s most common gynecologic malignancy but is understudied in the geographically and socioeconomically diverse state of Kentucky (KY). This study assessed the frequency, distribution, and survival of uterine corpus malignancies in KY, and specifically the differences between Appalachia (AP) and non-Appalachia (NAP).

This study utilizes SEER and Kentucky Cancer Registries to study uterine corpus malignancy between January 1, 2000 and December 31, 2014. The analysis looks at incidence between diagnoses in AP and NAP. Evaluation criteria includes: tumor histology (Type I, Type II, sarcoma, and mixed uterine malignancy), age, race, smoking status, stage at diagnosis, insurance …

Evaluating A Multidisciplinary Integrated Management Team Intervention To Improve Maternal And Child Outcomes And Hiv Service Uptake And Retention In Lesotho, Project Soar

HIV and AIDS

Pregnant and postpartum HIV-positive women face a particularly complex set of barriers to prevention of mother-to-child transmission of HIV (PMTCT) uptake at the policy, health facility, community, and individual levels. They are vulnerable to poor retention in care and adherence to treatment, especially in the first three months after initiation of treatment and the postpartum period. In addition, counseling and support for primary prevention among HIV-negative pregnant women is almost nonexistent in PMTCT programs. This brief describes the IMPROVE study—a multidisciplinary integrated management team intervention to increase maternal and child health and HIV service uptake and retention—that Project SOAR is …

Modeling The Expected Cost-Effectiveness And Impact Of Oral Pre-Exposure Prophylaxis In Uganda And Swaziland, Project Soar

HIV and AIDS

Clinical trials have shown that oral antiretrovirals (ARVs) containing tenofovir/emtricitabine used by HIV-negative individuals to prevent HIV acquisition, called oral pre-exposure prophylaxis (PrEP), are safe and effective in several populations. Prior modeling work has demonstrated that oral PrEP is most cost effective when targeted to populations at very high risk of infection, with risk dependent on a combination of individual behavior and epidemic contexts. This brief describes a study Project SOAR is conducting to assist Uganda and Swaziland in making critical decisions about oral PrEP introduction and scale up by modeling the expected cost effectiveness and impact of oral PrEP …

What’S Coming For Health Science And Policy In 2018? Global Experts Look Ahead In Their Field, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Peter Byass

Department of Paediatrics and Child Health

No abstract provided.

The Impact Of Sarcopenic Obesity On Inflammation, Lean Body Mass, And Muscle Strength In Elderly Women, Dahan Da Cunha Nascimento, Samuel Da Cunha Oliveira, Denis Cesar Leite Vieira, Silvana Schwerz Funghetto, Alessandro Oliveira Silva, Renato Valduga, Brad J. Schoenfeld, Jonato Prestes

Publications and Research

Objective: The objective of this study was to apply the newly standardized definition for sarcopenia from the Foundation for the National Institutes of Health (FNIH) and the current definition for obesity to 1) determine the prevalence of sarcopenic obesity (SO) in obese elderly women; 2) compare the muscle strength, lean body mass, and markers of inflammation between obese elderly women with SO and nonsarcopenic obesity (NSO), and 3) elucidate the relation- ship between appendicular lean mass adjusted for body mass index (aLM/BMI) with muscle strength, lean body mass, and obesity indices.

Methods: A total of 64 elderly obese women (age: …

Whether, When, And How: Fertility Intentions And Age In The U.S., Andrea Melnikas

Dissertations and Theses

Thinking about, planning for, and having children is a deeply personal experience influenced by myriad factors at individual, intrapersonal, community and larger social levels. Examining fertility intentions is of interest to researchers from numerous social science disciplines in part because these intentions are potentially tied to larger demographic and economic shifts. In recent years in the U.S. the mean age at first birth has been increasing, with more women of older ages (age 35 and older) giving birth, due to both delays in childbearing that accompanied larger social trends such as increased educational and career opportunities and a decrease in …

How Are Educated Women In Ghana Regulating Fertility Without High Levels Of Modern Contraceptive Use?, Kazuyo Machiyama, Cicely Marston, Nancy Termini Lachance, Terence Adda-Balinia, Placide Tapsoba

Reproductive Health

While Ghana has made striking gains in enabling its women to use family planning to reduce family size—the total fertility rate shifted from 7.0 to 4.2 children per woman from the 1970s to the 2010s—the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) studies found that educated women in Ghana are achieving their fertility goals by limited use of highly effective contraceptive methods. Their fertility regulation strategies involve contraceptive method mosaics that have not been captured by the DHS. This evidence summary aggregates research from the STEP UP Research Programme Consortium along with other related evidence to explore this …

Expanding Access To Family Planning For Married Adolescent Girls In The Urban Slums Of Dhaka, Fauzia Akhter Huda, Nancy Termini Lachance

Reproductive Health

Early pregnancy is associated with adverse health, social, and economic consequences for girls, and Bangladesh has an adolescent fertility rate that is among the highest in the region. Poor, slum-dwelling girls are especially vulnerable. This policy brief outlines a project that icddr,b, a STEP UP project partner, initiated to test three innovative strategies aiming to support the unmet family planning needs of these girls. This brief concludes with government-level policy and program recommendations based on the evidence of this project for leveraging existing government health programs to better serve the needs of married adolescent girls and reduce their risks of …

Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte

Reproductive Health

This brief summarizes evidence on the benefits of family planning for girls and women, their children, families, and societies. It also provides evidence on the cost-effectiveness of family planning programs; discusses reasons for unmet need for contraception and identifies ways to reduce unmet need and discontinuation; and describes progress in meeting FP2020 and the Sustainable Development Goals (SDGs). To meet the FP2020 and SDGs, significant investments are required by countries and donors in the following priority areas: sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, improving the quality of services, increasing the range …

Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte

Reproductive Health

Expanding the range of contraceptive options helps individuals to make choices appropriate to their needs and circumstances, allows them to switch from one method to another if desired, and reflects a program focus on quality and rights. This policy brief outlines policy and program considerations in order to establish and maintain well-functioning supply chains for an expanded choice of contraceptives: introducing new contraceptive technologies to satisfy the diverse preferences of women and their partners; overcoming access barriers to existing methods such as adverse economic and social circumstances, including gender norms; and maximizing the potential of expanded contraceptive choice by ensuring …

Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows

Reproductive Health

Increasing efficient and effective investment in family planning (FP) through the public and private sectors is key to meeting the FP2020 goal of helping 120 million additional women become modern contraceptive users. This policy brief identifies several policy and program considerations to ensure adequate financing of family planning commodities and services: sustained fundraising, pooling, and strategic purchasing; reaching new users and improving continuation rates among current users; and conducting further research on family planning quality performance metrics to test their correlation with higher continuation rates. Future efforts to reduce unmet need for FP must consider consumers’ out-of-pocket costs, programmatic cost-effectiveness, …

Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli

Reproductive Health

Interventions to reduce unmet need for contraception and early and unintended pregnancies among adolescents should be critical components of family planning programs in developing countries. This evidence brief highlights evidence and provides research and program considerations for improving access to family planning and reducing unintended pregnancy. It describes the following five elements that must be in place in order to apply evidence to large-scale, national-level programs: collect, analyze, and use accurate and up-to-date data; formulate or revise national laws and policies; develop national adolescent sexual and reproductive health strategies; implement strategies with careful monitoring; and conduct periodic program reviews.