Public Health Commons^™

A Spatiotemporal Model For Repeated Imaging Data, Brandon George

All ETDs from UAB

Longitudinal imaging studies have increased in popularity as clinical researchers seek to investigate how phenomena within the body change over time. Analysis of data from these studies is complicated by correlation between repeated measures over time and different locations in the body. To address this problem we propose the use of a linear model with a separable parametric correlation structure. This model considers spatial and temporal correlation independently and incorporates the correlation using parametric functions that have the potential to be much more efficient than an unstructured approach. Our model also has the ability to control for time- and space-varying …

First-Year Male Students' Adherence To Traditional Male Gender Roles And Their Attitudes Toward Bystander Approach Behaviors To Stop Sexual Assault, Kamal M. Harb

Doctoral Dissertations

Sexual assault on university campuses may affect any person at any time. However, university-aged women are disproportionally affected by it, with 25% of women reporting being assaulted on campus, and 84% to 97.8% of them perpetrated by young, heterosexual men known to the victim. To curb sexual assault on the university campus, research studies have advocated for the bystander approach. It encourages bystanders (observers) to intervene and ultimately stop a potentially dangerous situation in which a friend or stranger may experience a sexual assault. Despite its popularity, research studies evaluating the bystander approach have reported, at best, modest success with …

Using Sensewear Armband And Diet Journal To Promote Adolescents' Energy Balance Knowledge And Motivation, Senlin Chen, Xihe Zhu, Gregory J. Welk, Youngwon Kim, Jungmin Lee, Nathan F. Meier

Human Movement Studies & Special Education Faculty Publications

Purpose: Educating adolescents about energy balance (EB) is essential for effective weight control. This study utilized the Sensewear (SWA) armband and a diet journal to promote adolescents' EB knowledge and motivation.

Methods: Ninety sixth graders were randomly assigned into the experimental group (n = 46) who utilized SWA and diet journal for 7 consecutive days or the control group (n = 44) who did not. Both groups were pre-and post-measured on EB knowledge, situational interest, and weight. The experimental group was tracked on motivation effort, energy expenditure (EE), and energy intake (EI).

Results: EB knowledge significantly increased and situational interest …

The Increasing Weight Of Regulation: Countries Combat The Global Obesity Epidemic, Allyn L. Taylor, Emily W. Parento, Laura A. Schmidt

Georgetown Law Faculty Publications and Other Works

Obesity is a global epidemic, exacting an enormous human and economic toll. In the absence of a comprehensive global governance strategy, states have increasingly employed a wide array of legal strategies targeting the drivers of obesity. This article identifies recent global trends in obesity-related legislation and makes the normative case for an updated global governance strategy.

National governments have responded to the epidemic both by strengthening traditional interventions and by developing novel legislative strategies. This response consists of nine important trends: (1) strengthened and tailored tax measures; (2) broader use of counter-advertising and health campaigns; (3) expanded food labeling; (4) …

Expanding The Evidence Base On Comprehensive Care For Survivors Of Sexual Violence In Sub-Saharan Africa, Population Council

Reproductive Health

The Expanding the Evidence Base on Comprehensive Care for Survivors of Sexual Violence in sub-Saharan Africa program was a four-year agreement between the Swedish-Norwegian Regional HIV and AIDS Team for Africa, Embassy of Sweden, Lusaka (the S-N Team), and the Population Council. From 2009 to 2013, the program sought to mitigate the impact and incidence of sexual and gender-based violence (SGBV) in sub-Saharan Africa by strengthening the capacities of medical, legal, and justice sectors to care for survivors of such violence. This approach was intended to serve the S-N Team’s larger development objectives of preventing HIV transmission in sub-Saharan Africa …

Evaluation Of The Impact Of The Voucher Program For Improving Maternal Health Behavior And Status In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Syed Abu Jafar Md. Musa, Ashish Bajracharya, Kaji Tamanna Keya, Forhana Rahman Noor, Eshita Jahan, Md. Irfan Hossain, Jyotirmoy Saha, Benjamin Bellows

Reproductive Health

Vouchers, a demand-side financing (DSF) instrument for health-care services, were introduced in Bangladesh in 2006. The DSF program grants vouchers to pregnant women to receive free antenatal, delivery, and postpartum care services as well as free medicine, and financial assistance is provided for transportation. Deliveries with skilled service providers are financially incentivized and providers are reimbursed for their services from a special fund. After piloting DSF initially in 21 subdistricts (upazilas), the government expanded it to another 12 upazilas in 2007 (the second phase), and in its third phase in 2010 the program was expanded to another 11 upazilas. To …

Barriers To Obstetric Fistula Treatment In Low-Income Countries: A Systematic Review, Benjamin Bellows, Rachel Bach, Zoe Baker, Charlotte E. Warren

Reproductive Health

Obstetric fistula is a maternal morbidity condition that occurs in some low-income countries and is caused by prolonged obstructed labor that results in a hole between the vagina and the bladder or rectum through which urine or feces leak. Unrepaired fistula can lead to lifelong ostracism, stigma, and shame. Obstetric fistula is preventable and treatable, but women in these countries experience delays in seeking repair due to a number of factors including awareness of their condition as well as the potential for treatment, resources necessary for seeking care, lack of skilled fistula surgeons, and long hospital waiting times. UNFPA estimates …

Social Accountability: What Are The Lessons For Improving Family Planning And Reproductive Health Programs?, Victoria Boydell, Jill Keesbury

Reproductive Health

The concept of accountability is increasingly important in the family planning (FP) and reproductive health (RH) field. While much recent discussion has focused on developing global or national-level mechanisms for accountability, less emphasis has been placed on understanding the relevance of “social accountability” approaches for ensuring access to, and quality of, FP/RH services. Social accountability refers to the efforts of citizens and civil society to scrutinize and hold duty bearers (politicians, government officials, and service providers) to account for providing promised services, actions most often at the subnational or community level. In the FP/RH field, this concept builds on a …

Research Gaps In Scale Up Of Family Planning And Reproductive Health Programming, The Evidence Project, E2a, Hpp, Measure Evaluation

Reproductive Health

The Evidence Project, in collaboration with the Evidence to Action Project, the Health Policy Project, and MEASURE Evaluation convened a meeting to discuss research gaps related to scale-up. The meeting was held at the request of USAID’s Office of Population and Reproductive Health (OPRH) to help guide their research strategy. The meeting had four objectives: discuss scale-up experiences and the role of research and monitoring for strengthening program performance at scale; identify research gaps related to scale-up; prioritize the scale-up research gaps for OPRH; identify next steps for addressing these priority research gaps. This meeting generated a rich discussion about …

Strengthening The Evidence Base On Social Accountability For Improving Family Planning And Reproductive Health Programs, Victoria Boydell, Jill Keesbury, Kelsey Wright

Reproductive Health

The concept of accountability is important in the family planning (FP) and reproductive health (RH) sector, building on a rich history of community involvement and civil society participation. There are three categories of FP/RH accountability initiatives: tracking donor and government financial commitments, tracking national-level program implementation, and tracking service-delivery outcomes. The third category, often referred to as “social accountability,” includes the efforts of citizens and civil society to scrutinize and hold duty bearers to account for providing promised services, most often at the subnational or community levels. Social accountability is premised on the assumption that increased and targeted citizen and …

Assessing The Potential Market For A Progesterone Contraceptive Vaginal Ring (Pcvr) As A New Contraceptive Option In Sub-Saharan Africa Using Needs-Based Market Segmentation, Francis Obare, Deepa Rajamani, Saumya Ramarao

Reproductive Health

Developing countries, especially in sub-Saharan Africa, have disproportionately high unmet contraceptive needs compared to other regions, and especially high levels of unmet need for spacing pregnancies. To address some of sub-Saharan Africa’s barriers to effective contraception, there is renewed focus on new methods that offer greater ease of use. New methods under investigation would not require daily action, their use would be controlled by women themselves, and they would require no medical providers or significant health-system infrastructure for service delivery. Contraceptive vaginal rings hold great potential by offering not only ease of use but a safe and effective FP solution. …

Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Mexico, Karla Berdichevsky, Claudia Diaz, Katharine Mccarthy, Ann K. Blanc

Reproductive Health

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To help accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate the indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. …

Achieving Mdgs 4 And 5 In Balochistan: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Balochistan government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Balochistan—about 35 percent of the deaths in this age group are pregnancy-related. Approximately 3,000 women die each year in Balochistan due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. The maternal …

Achieving Mdgs 4 And 5 In Khyber Pakhtunkhwa: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Khyber Pakhtunkhwa (KP) government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in KP—about 27 percent of the deaths in this age group are pregnancy-related. Approximately 1,700 women die each year in KP due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. …

Increasing Access To Family Planning In Ghana Through Policy Change: Task-Sharing To Enable Auxiliary Nurses To Provide Contraceptive Implant Services, Population Council

Reproductive Health

Ghana has made significant progress toward reducing the maternal mortality ratio but the rate is still unacceptably high. Up to 26 percent of married Ghanaian women have unmet need for family planning and one in four currently married women is using a modern contraceptive method. Satisfying unmet need for family planning could cut the number of maternal deaths by almost a third. One factor contributing to low usage of modern methods is shortage of trained staff, particularly those skilled in providing long-acting reversible and permanent methods. Until recently, implant services were provided primarily by Ghana Health Service (GHS) trained midwives, …

Achieving Mdgs 4 And 5 In Sindh: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Sindh government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Sindh—about 24 percent of the deaths in this age group are pregnancy-related. Approximately 2,800 women die each year in Sindh due to pregnancy-related causes despite some recent improvement in reproductive health indicators. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family …

An Evaluation Of Population Services Zimbabwe’S Mobile Outreach Model, Ravikanthi Rapiti, Saiqa Mullick

Reproductive Health

This report documents a service evaluation of Population Services Zimbabwe’s (PSZ) mobile outreach program in four provinces of Zimbabwe. The evaluation was conducted by the Population Council between September and October 2013. It provides key findings on the quality of the PSZ outreach program in expanding choice and access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of contraception, as well as recommendations for PSZ and other family planning programs to consider in scaling up and strengthening mobile outreach services. The evaluation, conducted by the Population Council, was designed to focus on various components of quality including adequate information …

Facilitator's Guide For Training On Monitoring And Evaluation Of Social And Behavior Change Communication Health Programs, Praween Kumar Agrawal, Kumudha Aruldas, M.E. Khan, Subrato Mondal

Reproductive Health

Social and behavior change communication (SBCC) interventions are now incorporated within state project implementation plans and increasing resources are being allocated for SBCC activities. A close monitoring of SBCC activities and an evaluation in terms of reach and effectiveness among intended audiences is thus necessary. This calls for a serious effort to build the capacity of monitoring and evaluation (M&E) personnel to monitor and evaluate performance of SBCC activities. FHI 360’s Improving Healthy Behaviors Program, funded by USAID, aims to provide technical assistance to strengthen the capacities of public program managers at the national, state, and district level to monitor …

Increasing Choice Of And Access To Family Planning Services Via Outreach In Rajasthan, India, Kumudha Aruldas, M.E. Khan, Jaleel Ahmad, Anvita Dixit

Reproductive Health

This report documents a service evaluation of Marie Stopes (MS) India’s mobile outreach program in the state of Rajasthan, which was conducted by the Population Council between March and October 2012. This study was made possible through the United States Agency for International Development (USAID)-funded Support for International Family Planning Organizations–Marie Stopes International project. It provides important findings on the safety and effectiveness of MS India’s outreach program in expanding choice and access to long-acting reversible contraception methods and voluntary surgical permanent methods of contraception, as well as recommendations for MS India and other family planning programs to consider in …

Induced Abortions And Unintended Pregnancies In Pakistan, 2012, Population Council

Reproductive Health

The 2012–13 PDHS (Pakistan Demographic and Health Survey) shows that gains in contraceptive prevalence over the past decade have been small, and unmet need has remained high. Using data from a 2012 national study on post-abortion care, we estimate 2.2 million abortions occurred in Pakistan in 2012, and an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 for 2002. Even accounting for an underestimation of abortion incidence (private sector abortion services could not be included) in the prior study, the abortion rate in Pakistan has likely increased substantially between 2002 and …

Maternal Health Commodity Landscaping Exercise: A Snapshot Of The Bangladesh Program, Sharif M.I. Hossain, Saumya Ramarao, Ismat Ara Hena, Ubaidur Rob

Reproductive Health

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation’s Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country’s policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders …

Reaching The Unreached Through Community Mobilization In An Innovative And Sustainable Way, Arupendra Mozumdar, M.E. Khan, Subrato Mondal

Reproductive Health

This study shows the potential of Self Help Groups (SHGs) to deliver health messages that increase women’s knowledge. The intervention for this operations research (OR) study included a day-long training for Swasth Sakhis in the experimental area. A total of 11 trainings were organized, all conducted by Population Council staff. Before the intervention, at baseline, 803 women from eligible households were interviewed for the quantitative assessment. At endline, 470 women were followed up. Additionally, 16 in-depth interviews with women, Swasth Sakhis, and Rajiv Gandhi Mahila Vikas Pariyojana staff were conducted in the experimental area to understand how the intervention was …

Sexual And Reproductive Health Of Women Living With Hiv In Egypt: Unmet Needs And Unfulfilled Dreams, Doaa Oraby, Nahla G. Abdel-Tawab

Reproductive Health

The gender profile of the HIV/AIDS epidemic has changed since it emerged 30 years ago when infections were concentrated in key populations of men such as injecting drug users and men who have sex with men. In 2012, women accounted for nearly 50 percent of the estimated 35.3 million people living with HIV/AIDS globally. In the Middle East and North Africa, 44 percent of infected adults are women. The past 30 years have also witnessed remarkable improvements in access to high-quality information and medical services, including services for prevention of mother-to-child transmission of the virus. With care and treatment for …

Prioritizing Family Planning For Achieving Provincial Maternal Child Health And Development Goals, Zeba Sathar, Muhammad Asif Wazir, Maqsood Sadiq

Reproductive Health

This report presents an argument for prioritizing family planning to achieve the maternal, child, and development goals of four major provinces in Pakistan, using the latest available provincial data, especially the Pakistan Demographic and Health Survey 2012-13. The analysis is based on provincial projections generated by the Population Council. Opportunities for enhancing family planning are identified, and the number of maternal, infant, and child lives that could be saved in each province through an accelerated family planning program is estimated. The analysis establishes that none of the provinces are on track to meet Millennium Development Goals 4 or 5. The …

Operationalizing A Proposed National Protocol For The Prevention And Management Of Severe Pre-Eclampsia And Eclampsia Using A Loading Dose Of Magnesium Sulphate At Community Health Facilities In Bangladesh, Population Council

Reproductive Health

About 20 percent of maternal deaths in Bangladesh are caused by pre-eclampsia and eclampsia. Most of these deaths, which occur during care within local communities due to lack of maternal health information, poor antenatal care attendance, and delays in seeking care, can be easily prevented with low-cost maternal health commodities. A quasi-experimental pre- and post-test study, with no control group, was implemented to assess the abilities of community facility service providers to screen and detect eclampsia patients, administer a loading dose of magnesium sulphate to diagnosed patients, and refer them to an appropriate facility for condition management. These interventions were …

Kenya Country Profile: A Status Check On Unintended Pregnancy In Kenya, Joyce Mumah, Jessica Brinton, Caroline W. Kabiru, Carol Mukiira, Chimaraoke O. Izugbara

Reproductive Health

Kenya’s mothers are dying at an alarming rate: a woman giving birth in Kenya has a 1 in 38 chance of dying due to inadequate reproductive health services. In response, in 2014 Kenya’s First Lady Margaret Kenyatta launched the Beyond Zero campaign to create awareness and raise funds to tackle maternal mortality and morbidity and improve child health. This brief offers six policy and programmatic recommendations to address significant sexual and reproductive health challenges highlighted throughout the report. These recommendations take into account the policy context in Kenya, which is evolving at a rapid rate in part because of the …

Improving Family Planning Services In Public Health Facilities To Reach More Women, Caroline W. Kabiru, Jessica Brinton, Joyce Mumah, Carol Mukiira, Chimaraoke O. Izugbara

Reproductive Health

Although Kenya has made significant progress in ensuring its citizens’ right to reproductive health, many Kenyans still lack access to or fail to use contraceptives, in part because of the lack of quality family planning (FP) services. Through the STEP UP research program, the African Population and Health Research Center developed a comprehensive country profile report that outlines the status, causes, and consequences of unintended pregnancy in Kenya. One of the most prominent findings was how important public health facilities are to reducing unmet need for FP. In order to solidify gains achieved and make further progress, concerted commitment from …

Reducing Unsafe Menstrual Regulation Through Medication In Bangladesh, Ubaidur Rob, Ismat Ara Hena, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council and Marie Stopes Bangladesh, in collaboration with the Directorate General of Family Planning and with funding from the World Health Organization, tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed the acceptability of providing MRM using the combination drug regimen mifepristone and misoprostol in urban and rural public health facilities. As reported in this policy brief, the study demonstrates that it is feasible and safe to introduce MRM in rural and urban public health facilities. Given the choice, almost two-thirds of women preferred MRM to manual vacuum aspiration and women receiving MRM …

Comprendre Les Grossesses Non Désirées Au Sénégal: Rapport Du Profil Pays, Kaila Clarke, Mohamadou Sall, Babacar Mane, Nafissatou Diop, Bocar Mamadou Daff

Reproductive Health

Dans le cadre du programme de recherche « Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) », le Population Council a élaboré un Rapport du Profil Pays pour comprendre les grossesses non désirées au Sénégal. Ils ont mené une revue de la littérature, analysé des données d'enquêtes disponibles, et a mené des entretiens pour discuter plus en détail de certains aspects avec quelques parties prenantes clés. Le Profil Pays a été discuté lors d’un atelier de deux jours à Dakar regroupant les principaux acteurs du gouvernement aux niveaux central et régional, des organisations non-gouvernementales, et des acteurs de la …

Understanding Unintended Pregnancy In Senegal: Country Profile Report, Kaila Clarke, Mohamadou Sall, Babacar Mane, Nafissatou Diop, Bocar Mamadou Daff

Reproductive Health

As part of the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) research program, the Population Council has developed a Country Profile Report to understand unwanted pregnancies in Senegal. The Population Council conducted a literature review, analyzed available survey data, and conducted interviews to discuss some aspects in more detail with a number of key stakeholders. The Country Profile was discussed at a two-day workshop in Dakar bringing together key government actors at the central and regional levels, nongovernmental organizations, and civil society actors. The report is composed of six chapters, summarized in this evidence brief.