International Public Health Commons^™

Community-Based Hiv Treatment Service Delivery Model For Female Sex Workers In Tanzania: Evaluation Findings, Lung Vu, Waimar Tun, Louis Apicella, Jeremiah Kidola, Caterina Casalini, Gasper Mbita, Neema Makyao, Todd Koppenhaver, Erick Mlanga

HIV and AIDS

Project SOAR in collaboration with the National AIDS Control Program of the Government of Tanzania, National Institute of Medical Research, and Jhpiego’s Sauti Program, conducted an implementation science study to investigate the delivery of community-based antiretroviral treatment (ART) services to female sex workers (FSWs) in Tanzania. Studies from sub-Saharan Africa have shown improved HIV treatment outcomes, such as uptake of HIV services, retention in care, and increased dignity and quality of life, by using community-based delivery of HIV services. As detailed in this Project SOAR final report, the study assessed the effectiveness of the community-based ART delivery intervention in improving …

Strengthening Capacity For Assessment Of Hiv-Related Data Needs Among Key Populations To Inform Evidence-Based Responses, Amrita Rao, Nikita Viswasam, Stefan Baral

HIV and AIDS

Defining the HIV prevention and treatment needs of key populations who have disproportionate HIV acquisition and transmission risks has been particularly difficult in the context of generalized HIV epidemics where less attention has historically been placed on the HIV prevention and treatment needs of these groups. There is a gap in our understanding of the specific needs of—and ultimately the investment case for the added value of supporting—disproportionately burdened key populations in these settings. In response to this gap, Johns Hopkins University under the United States Agency for International Development (USAID)-funded Project SOAR implemented a project in partnership with collaborators, …

Considerations For Collecting And Documenting Fgm/C Data By Health Care Providers, Dennis Matanda

Reproductive Health

Data on female genital mutilation/cutting (FGM/C) are rarely collected in health facilities, yet routine collection of facility-based data through other health-seeking visits (e.g., during antenatal care) is considered good medical practice and can be an important source of data. Clinical exams provide an opportunity to identify women and girls who have undergone FGM/C, which is an important step in aiding the prevention of chronic complications that can be difficult to manage later in life. These exams also make it possible to refer those with FGM/C-related complications for specialized treatment. Clinical visits also present an opportunity to discuss prevention of the …

Female Genital Mutilation/Cutting In Senegal: Is The Practice Declining? Descriptive Analysis Of Demographic And Health Surveys, 2005–2017, Dennis Matanda, Glory Atilola, Zhuzhi Moore, Paul Komba, Lubanzadio Mavatikua, Chibuzor Christopher Nnanatu, Ngianga-Bakwin Kandala

Reproductive Health

To achieve the Sustainable Development Goals, female genital mutilation/cutting (FGM/C) is one of the most prominent issues world leaders and governments must address. In Senegal, estimates from the 2017 Senegal Demographic and Health Survey show that almost a quarter of women aged 15–49 have undergone FGM/C, while 14 percent of girls aged 0–14 years have been cut. Given the many interventions that have been implemented in Senegal with the intention of scaling down FGM/C rates, the key question is: To what extent has the practice declined? The aim of this study, as presented in this working paper, was to generate …

Understanding Female Genital Mutilation/Cutting Abandonment In Egypt, Nada Wahba, Hania El Banhawi, Amira El Ayouti

Reproductive Health

Although the prevalence of female genital mutilation/cutting (FGM/C) in Egypt among married women aged 15–49 years is high (92 percent), in the most recent (2014) Demographic and Health Survey, prevalence rates appear to be declining among younger cohorts of girls and women. Support for the discontinuation of the practice is more widespread in younger generations, among females, and among those living in urban areas. Variations in attitudes toward FGM/C by education level and wealth status are also documented. While numerous studies have examined the reasons why people practice FGM/C, few studies have examined the characteristics of the individuals who have …

Health Care Providers' And Mothers' Perceptions About The Medicalization Of Female Genital Mutilation Or Cutting In Egypt: A Cross-Sectional Qualitative Study [Arabic], Omaima El-Gibaly, Mirette Aziz

Reproductive Health

The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explore the drivers and motives behind why health-care professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters.

No To Circumcision’: The Road To Effective Social Marketing Campaigns In Egypt [Arabic], Salma Abou Hussein, Sarah Ghattass

Reproductive Health

This study sought to understand how, where, and why social marketing campaigns (SMCs) supporting abandonment of female genital mutilation/cutting (FGM/C) are working, and with what impact, to inform design and scale-up of campaigns that can foster new perspectives, expectations, and behaviors.

A Diagnostic Assessment Of The Health System's Response To Fgm/C Management And Prevention In Nigeria—Brief, Osasuyi Dirisu, Adetayo Adetunji, Mayokun Adediran, Otibho Obianwu

Reproductive Health

Globally, over 200 million women have been cut and are living with FGM/C-related consequences. In Africa, an estimated 27 million, 24 million, and 20 million girls/women have undergone FGM/C in Egypt, Ethiopia, and Nigeria respectively, the countries with the highest prevalence of FGM/C on the continent. In Nigeria, although the practice is considered widespread, national surveys suggest a gradual decline of FGM/C prevalence among women aged 15–49 years from 30 percent in 2008 to 20 percent in 2018. While these statistics suggest progress, the prevalence is still as high as 67 percent in some states. Nigeria’s National Strategic Health Development …

A Diagnostic Assessment Of The Health System's Response To Female Genital Mutilation/Cutting Management And Prevention In Kenya: A Case Study Of West Pokot County, Samuel Kimani

Reproductive Health

Female genital mutilation/cutting (FGM/C), a pervasive cultural practice in some contexts, is associated with negative impacts on women’s and girls’ health and rights. The health sector is well positioned to respond to the prevention of FGM/C and the management of its complications because of its primary role in disease prevention, health promotion, and curative services. In Kenya, the health sector’s role is anchored in national and county legal and policy instruments and guidelines that are adopted or customized from global or regional frameworks as well as skills support tools approved by the World Health Organization. This brief highlights findings from …

Improving The Documentation Of Female Genital Mutilation Or Cutting (Fgm/C) Abandonment Interventions And Their Evaluations, Caroline W. Kabiru

Reproductive Health

Female genital mutilation/cutting (FGM/C) is internationally recognized as a violation of human rights. Consequently, there have been extensive efforts to promote the abandonment of the practice. There is limited evidence on the impact of many of the efforts, in part because many interventions are implemented by small organizations with inadequate resources to document and evaluate their activities. The complex nature of FGM/C interventions, as with other interventions aimed at addressing violence against women and girls, also makes it difficult to adequately document what is done, how, when, and with what results. Nonetheless, it is important that implementing organizations make every …

Introduction Of Dmpa-Sc Self-Injection In Ghana: A Feasibility And Acceptability Study Using Sayana® Press, Dela Nai, Patrick Aboagye, Kamil Fuseini, Elizabeth Tobey, Aparna Jain, Nora Maresh, Rebecca Fertziger

Reproductive Health

This research report describes results from an implementation science study that explored the feasibility and acceptability of administering depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) among health-care providers and family planning (FP) clients in Ghana. DMPA-SC is an injectable contraceptive method that can be self-administered. The study, conducted by the Population Council through the USAID-funded Evidence Project in collaboration with the Ghana Health Service, was implemented in rural, peri-urban, and urban areas of the Ashanti and Volta regions. A total of 150 health-care providers were trained to administer DMPA-SC and to train clients on self-injection. Clients assessed as being competent self-injected under the …

Reflections From Five Years Of Research On Fgm/C, Lori S. Ashford, Reshma Naik, Charlotte Greenbaum

Reproductive Health

From 2015 to 2019, the Evidence to End FGM/C research consortium took a fresh approach to examining the longstanding practice of female genital mutilation/cutting (FGM/C). The African-led program developed innovative research methods and uncovered new evidence about the practice and how it is changing—focusing on families and communities, and health and legal systems. This report documents the consortium’s research methods, the key lessons learned, capacity strengthening efforts, enhanced advocacy for research uptake, and recommendations. The research sheds light on key areas for future investments that would ensure that FGM/C policies and programs are informed by rigorous evidence. The recommendations stem …

Understanding Local Variation In How Female Genital Mutilation/Cutting Declines, Changes, Or Persists: Analysis Of Household Survey Data For Kenya, Nigeria, And Senegal, Population Reference Bureau

Reproductive Health

Efforts to eliminate female genital mutilation/cutting (FGM/C) intensified in many parts of Africa following a 2012 United Nations General Assembly Resolution, but change has been uneven. Important evidence gaps remain in our understanding of why the practice declines, changes, or persists in specific locations. Policymakers and program planners need such information to better tailor interventions to address local patterns and focus resources on abandonment efforts in areas with the greatest needs. To fill these gaps, researchers with the Evidence to End FGM/C consortium analyzed nationally representative household survey data for Kenya, Nigeria, and Senegal. The results of their research identify …

Female Genital Mutilation/Cutting In Nigeria: Is The Practice Declining? A Descriptive Analysis Of Successive Demographic And Health Surveys And Multiple Indicator Cluster Surveys (2003–2017), Ngianga-Bakwin Kandala, Glory Atilola, Chibuzor Christopher Nnanatu, Emmanuel Ogundimu, Lubanzadio Mavatikua, Paul Komba, Zhuzhi Moore, Dennis Matanda

Reproductive Health

This report gives insight into the scale and scope of the practice of female genital mutilation/cutting (FGM/C) among women aged 15–49 years and girls younger than 15 years in Nigeria. It also presents evidence on where FGM/C occurs and highlights the dynamics of change as well as the context surrounding the practice. The report explores in detail the practice of FGM/C from all available sources of nationally representative survey data from 2003 to 2017 and the most relevant contextual information on key factors associated over time with FGM/C. The ultimate objective of the report is to generate evidence to inform …

Associations Between Female Genital Mutilation/Cutting And Early/Child Marriage: A Multi-Country Dhs/Mics Analysis, Jamlick Karumbi, David Gathara

Reproductive Health

Over the last several decades, global efforts to end female genital mutilation/cutting (FGM/C) have intensified through the combined efforts of international and nongovernmental organizations (NGOs), governments, and religious and civil society groups. Evidence of the wider impacts of FGM/C and interventions for its abandonment is small but emerging. The practice of FGM/C has frequently been linked to a girl’s marriageability and is thought to be associated with child marriage, either directly, as a cause of early/child marriage, or vice versa, or indirectly, resulting from common causes. Evidence of the relationships between these two practices to inform programming and policy for …

Modelling And Mapping Of Regional Disparities Associated With Female Genital Mutilation/Cutting Prevalence Among Girls Aged 0–14 Years In Senegal: Evidence From Senegal (Sdhs) Surveys 2005–2017, Ngianga-Bakwin Kandala, Paul Komba, Chibuzor Christopher Nnanatu, Glory Atilola, Lubanzadio Mavatikua, Zhuzhi Moore, Dennis Matanda

Reproductive Health

Between 2005 and 2017, Senegal experienced a slight national decline in the prevalence of female genital mutilation/cutting (FGM/C) among women aged 15–49 years and girls younger than 15 years. However, significant differences in prevalence exist as a result of multifarious risk factors. Our previous research in Senegal described the national trends in FGM/C, showing where, when, and why FGM/C is practiced in Senegal. However, no recent study exists to analyze the geographical patterns of FGM/C and the effect of individual-and community-level risk factors on the likelihood of cutting among girls younger than 15 years. This working paper presents results from …

Modelling And Mapping Of State Disparities Associated With Female Genital Mutilation/Cutting Prevalence Among Girls Aged 0–14 Years In Nigeria: Evidence From Dhs And Mics 2003–2017, Ngianga-Bakwin Kandala, Paul Komba, Chibuzor Christopher Nnanatu, Glory Atilola, Lubanzadio Mavatikua, Zhuzhi Moore, Dennis Matanda

Reproductive Health

The practice of female genital mutilation/cutting (FGM/C) has been positioned as a gender and global development issue that national and international organizations must address for girls and women to thrive in good health and enjoy their fundamental rights. Consequently, many efforts have been made to promote the abandonment of the practice. Despite evidence of a decline in FGM/C, there are significant variations in its prevalence in many sub-Saharan African countries, where the practice persists due to the combined effects of factors among individuals as well as communities. This working paper presents findings from a study that analyzed existing data using …

Population Council Annual Evaluation Report: Opening Futures (Abriendo Futuros) For Indigenous Girls In Yucatan, Mexico, Silvana Larrea

Poverty, Gender, and Youth

This Population Council Annual Evaluation Report includes evaluation activities from December 1, 2015 to December 1, 2019, and future evaluation plans (2019–21), as part of the Opening Futures (Abriendo Futuros) project for indigenous girls in Yucatan, Mexico. The first section describes the finalized analysis of the impact evaluation of the pilot phase; the second section reports the progress of evaluation activities; and the third section includes an evaluation of future plans for the period December 1, 2019 to November 30, 2021.

Z4, A Slow Puncture: An Autoethnographic Exploration Of Language, Embodiment, And Meaning-Making, Charlotte Rose Samuels

Independent Study Project (ISP) Collection

In my ISP, I explored language as it relates to the ways in which people living in Cato Manor make sense of HIV/AIDS in their community. With 7.1-7.2 million people living with HIV (PLWHIV) in South Africa, individuals across the country are either infected or affected by illness. KwaZulu-Natal (KZN), the province with the highest rate of HIV, is also the province that was surveyed with the disproportionately highest internal stigma rates for PLWHIV. High prevalence of HIV, particularly in KZN, calls for a constant contextualization of life in the presence of illness.

Throughout the world, metaphor and symbolism is …

The Global Compact On Refugees: How The Sauti/Voice Project Fits, Josephine Ngebeh, Chi-Chi Undie, Joanina Karugaba

Reproductive Health

How can stakeholders support refugees in the present-day unprecedented global refugee crisis? At least one way is by entering into a clearly defined compact to do so. Developed in 2018, the Global Compact on Refugees is a nonbinding agreement among United Nations Member States and other relevant stakeholders, including international organizations. A symbol of political will, the Compact demonstrates the commitment of the international community to enhanced cooperation and solidarity with both refugees and their host communities. The Global Compact on Refugees provides the international community with guidance for supporting present-day refugee communities, characterized by large populations and protracted refugee …

Sauti/Voice Project: First Unhcr-Population Council Regional Workshop, Josephine Ngebeh, Chi-Chi Undie, Joanina Karugaba, George Odwe, Nachela Chelwa, Harriet Birungi, Michael Mbizvo

Reproductive Health

In 2014, the UNHCR East and Horn of Africa and Great Lakes (EHAGL) Africa Bureau in Nairobi, and the Population Council/Nairobi established technical cooperation for Improving Evidence-based Programming for Sexual and Gender-based Violence (SGBV) in Refugee Operations in the East and Horn of Africa. The Africa Bureau works closely with the Council to initiate appropriate interventions for the prevention of, and response to, SGBV in refugee operations. The Council’s technical team is represented by the Council-led Africa Regional SGBV Network. Technical cooperation between the Africa Bureau and the Council has resulted in a new initiative: VOICE—Violence Prevention and Response Through …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Kenya, Charlotte E. Warren, Pooja Sripad, Charity Ndwiga

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In …

Climate, Population, And Vulnerability In Pakistan: Exploring Evidence Of Linkages For Adaptation, G.M. Arif, Muhammad Riaz, Nadeem Faisal, Mohammad Jamal Khan Khattak, Zeba Sathar, Muhammad Khalil, Maqsood Sadiq, Sabahat Hussain, Kiren Khan

Poverty, Gender, and Youth

The global discussion of climate change and its impacts and causes has changed completely in the past quarter century. Scientific opinion now accepts that rapid warming is occurring and that greenhouse gases (GHG) emitted as a result of human activities are largely to blame. The consequences of taking no action will be catastrophic. Unfortunately, the burden of impact will fall disproportionately on the poor and most vulnerable people who rely heavily on agriculture in countries where average temperatures are already high. Climate change is particularly harmful because it increasingly threatens food security in these countries. Pakistan is one of the …

Antihypertensive Drugs, Population Council

Reproductive Health

Pre-eclampsia (PE) is a condition in pregnant women marked by an increase in blood pressure and protein in the urine after 20 weeks gestation. Eclampsia is a life-threatening condition characterized by convulsions in women with PE. PE/E and other hypertensive disorders in pregnancy increase risk of preterm births. Providing high-quality and regular antenatal care improves the prevention and early detection of PE and can prevent its progression to eclampsia. Prescribing low-dose aspirin and calcium to at-risk women can prevent PE and eclampsia. PE and eclampsia can be managed by administering antihypertensive drugs and magnesium sulphate (MgSO4). MgSO4 is the safest …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Bangladesh, Pooja Sripad, Sharif M.I. Hossain, Charity Ndwiga, Charlotte E. Warren

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically subordinate women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Ethiopia, Charlotte E. Warren, Pooja Sripad, Charity Ndwiga

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. …

Assessing The Effect Of A Primary Health Care Intervention For Improving Pre-Eclampsia And Eclampsia Knowledge And Practice In Bangladesh, Sharif M.I. Hossain, Shongkour Roy, Kanij Sultana, Charlotte E. Warren

Reproductive Health

In resource-poor countries such as Bangladesh, proven life-saving commodities for pregnant women have not been optimally examined, such as magnesium sulphate (MgSO4) to manage severe pre-eclampsia/eclampsia, use of anti-hypertensives to manage high blood pressure during pregnancy, aspirin prophylaxis for pregnant women at high risk of PE/E, as well as task shifting to lower health-worker cadres, and community involvement. There has been no systematic review of research and programming on PE/E prevention, early detection, and treatment in Bangladesh. With support from USAID, the Ending Eclampsia project has been expanding access to proven, underutilized interventions and commodities for PE/E prevention, early detection, …

Engaging Community Women’S Groups To Improve Maternal Health Care Delivery In Cross River: Implementation Research Report, Pooja Sripad, Emmanuel Nwala, Tracy Mcclair, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Ending Eclampsia’s main objective is to improve access to underutilized interventions and commodities by training community health extension workers in preventing, detecting (screening), and managing pre-eclampsia and eclampsia. While the broader project emphasizes primary health care interventions, this implementation research (IR) study focused on a community intervention in one state, in areas where the facility interventions were active. This final research report describes IR testing the feasibility and utility of employing women’s groups as community platforms to increase women’s access to quality antenatal service utilization, using pre-eclampsia screening as the entry point. The study was conducted in 48 communities in …

Feasibility And Acceptability Of Community Health Extension Workers To Identify And Treat Hypertension Associated With Pregnancy: Implementation Research Report, Emmanuel Nwala, Udochisom Anaba, Pooja Sripad, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy, experienced by 10 percent of women globally, are major contributors to maternal and newborn mortality, morbidity, and disability. Task shifting essential health services to mitigate insufficient human resources is recommended to strengthen and expand the health workforce and rapidly increase access to quality services. Nigeria’s task-shifting policy recommends that community health extension workers administer a loading dose of magnesium sulphate for severe pre-eclampsia or eclampsia prior to referral to a higher-level facility. This study tested the feasibility and acceptability of community health extension workers at primary health care facilities in Ebonyi state in detecting and managing …

Implementing Components Of The Primary Health Care Pre-Eclampsia/Eclampsia Model In Bangladesh: A Cost Analysis, Sharif M.I. Hossain, Pooja Sripad, Sara Chace Dwyer

Reproductive Health

Between 2016 and 2018, the Population Council, in collaboration with the Directorate General of Family Planning and Obstetrical and Gynecological Society of Bangladesh, implemented an intervention to confront pre-eclampsia/eclampsia (PE/E). This was part of the Ending Eclampsia project, a five-year USAID investment that implemented aspects of the Primary Health Care (PHC) PE/E Model in Bangladesh, Nigeria, and Pakistan. The intervention in Bangladesh comprised two components of the PHC for PE/E Model: 1) Task sharing to detect and manage PE/E (MgSO4 and referral) with PHC providers (Family Welfare Visitors, Sub-Assistant Community Medical Officers, and Nurse-Midwives), and 2) Introducing antihypertensive drug provision …