International Public Health Commons^™

Understanding Barriers To Clinical Management Of Rape (Cmr) Services Among Survivors Of Rape In Crisis Settings In Borno State, Osasuyi Dirisu

Reproductive Health

Sexual and gender-based violence (SGBV) is a global public health concern disproportionately affecting women, with negative consequences for their health, well-being, human rights, and equality. SGBV includes any act perpetrated against an individual that is against that person’s will and is predicated upon gender norms and unequal power relationships. SGBV occurs in crisis settings where vulnerability is increased, and social and legal sanctions are reduced. Internally Displaced Persons are vulnerable to SGBV during times of conflict as well as in post-conflict settings due to resultant losses of socioeconomic opportunities in addition to housing, security, lack of institutional protection, and familial …

Exploring Changes In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Fafan And West Arsi Zones, Ethiopia, Getaneh Mehari, Asabneh Molla, Ayantu Mamo, Dennis Matanda

Reproductive Health

Globally, more than 200 million women and girls have undergone FGM/C. More than half of these girls and women live in three high-prevalence countries: Egypt, Ethiopia, and Indonesia. Given the increase in population growth, recent estimates show that the number of girls and women subject to FGM/C will continue to rise in the coming years unless sufficient efforts are undertaken to encourage abandonment of the practice. A descriptive analysis of changes in FGM/C prevalence over time in Ethiopia shows that the percentage of women aged 15–49 years who report undergoing FGM/C has been declining. Despite the decline, the FGM/C prevalence …

Evidence To Support Hiv Prevention For Adolescent Girls And Young Women (Agyw) And Their Male Partners: Results From Malawi Dreams Studies With Agyw, Male Partners Of Agyw, Men Living With Hiv, And Program Implementing Partners, Nanlesta Pilgrim, Victor Mwapasa, Effie Chipeta, Wanangwa Chimwaza Manda, Nrupa Jani, Tracy Mcclair, Lyson Tenthani, Sanyukta Mathur

HIV and AIDS

Project SOAR, led by the Population Council, in partnership with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted a research portfolio to generate evidence to reduce HIV risk among adolescent girls and young women (AGYW) and their male partners. The objectives of this implementation research were to generate evidence for describing HIV-related risk factors among AGYW; assess the extent to which the overall DREAMS project contributed toward the goal of reducing HIV risk among AGYW; and understand the characteristics of male partners and how to link them to HIV services, as well as retain …

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 …

Assessing The Role Of Law In Reducing The Practise Of Fgm/C In Kenya, Agnes K. Meroka-Mutua, Daniel Mwanga, Charles Owuor Olungah

Reproductive Health

Criminalization is an important aspect of anti-FGM/C policies and programs. In countries where FGM/C is practiced, the enactment of a law prohibiting the practice is an important indicator of progress toward abandonment. Criminalization is often seen as playing an important role in the declining prevalence of FGM/C. However, there is not much research on the link between the enactment of laws that prohibit and criminalize FGM/C and declining prevalence of the practice. The objectives of this study, therefore, were to assess the extent to which people obey the law on FGM/C; to investigate the reasons and causes that motivate people …

Examining Access To Sexual And Reproductive Health Care Services And Information For Young Women With Physical Motor Disabilities In Dakar, Senegal, Olivia Soule, Diatou Sonko

Undergraduate Research Symposium

Access to and use of sexual and reproductive health (SRH) services in Senegal remains low despite local and international interventions and campaigns to increase contraception use, increase knowledge regarding Sexually Transmitted Infections (STI), and increase access to reproductive health services. Among marginalized groups, such as people living with disabilities, access to and use of services and information are even lower, and there are gaps in research involving Senegalese people with disabilities and their access to and use of SRH services and information. This mixed-methods, community-based participatory research examines how Senegalese women navigate their sexual and reproductive health care. It seeks …

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.

Endemic Human Coronaviruses In Hospitalized Adults With Community-Acquired Pneumonia: Results From The Louisville Pneumonia Study, Forest W. Arnold, Mark V. Burns, Kamran Mahmood, Darmaan Aden, Stephen P. Furmanek, Mahder A. Tella, Connor Glick, Anupama Raghuram, Leslie A. Beavin, Rodrigo Cavallazzi, Dawn Balcom, Leslie A. Wolf, Kenneth E. Palmer, Ruth Carrico, Julio A. Ramirez, The Center Of Excellence For Research In Infectious Diseases (Cerid) Coronavirus Study Group

The University of Louisville Journal of Respiratory Infections

Introduction: There are four endemic serotypes of human coronavirus (HCoV) that may cause community-acquired pneumonia (CAP) in humans. The clinical syndrome of CAP due to HCoVs is not well characterized. The objectives of this study were to evaluate incidence, epidemiology, and outcomes of CAP in adults due to HCoV and to compare them with CAP due to influenza.

Methods: The Louisville Pneumonia Study (LPS) is a prospective observational study of hospitalized adult patients with CAP in the city of Louisville. Patients enrolled in the LPS in whom a respiratory viral panel polymerase chain reaction (PCR) was obtained were evaluated. Incidence, …

Community-Acquired Pneumonia Due To Endemic Human Coronaviruses Compared To 2019 Novel Coronavirus: A Review, Julio A. Ramirez, Ruth Carrico, Rodrigo Cavallazzi, Leslie A. Beavin, Anupama Raghuram, Mark V. Burns, Kamran Mahmood, Darmaan Aden, Angeline Prabhu, Dawn Balcom, Stephen P. Furmanek, Leslie A Wolf, Kenneth E. Palmer, Mahder A. Tella, Connor Glick, Forest W. Arnold, The Center Of Excellence For Research In Infectious Diseases (Cerid) Coronavirus Study Group

The University of Louisville Journal of Respiratory Infections

The human coronaviruses (HCoVs) are an important etiology of community-acquired respiratory tract infections. Community-acquired pneumonia (CAP) may be caused by serotypes of endemic HCoVs or highly pathogenic HCoVs. In this review, we compared clinical characteristics, management, outcomes, and infection control practices for patients with CAP due to endemic HCoVs versus patients with CAP due to 2019 novel coronavirus (SARS-CoV-2).

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 …

Development Of A Diabetes Self-Management + Mhealth Program: Tailoring The Intervention For A Pilot Study In A Low-Income Setting In Mexico, Robin Whittemore, Mireya Vilar-Compte, Soraya Burrola-Méndez, Annel Lozano-Marrufo, Roberta Delvy, Mariana Pardo-Carrillo, Selene De La Cerda, Ninfa Pena-Purcell, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed.

Method: Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies …

Developing An Indicator System For A Healthy City: Taking An Urban Area As A Pilot, Tingting Li, Yong Fang, Dewei Zeng, Zumin Shi, Manoj Sharma, Huan Zeng, Yong Zhao

Environmental & Global Health Faculty Research

Purpose: The Healthy Cities Project is an important strategy for global health. This study aimed to develop a scientific and appropriate indicator system for the evaluation of a Healthy City in Chongqing, China. Methods: Data were collected via a review of government documents, focus group discussions, and in-depth interviews. A total of 34 government documents were reviewed to build the indicator database based on our previous studies. The first round of focus group discussions, which involved eight health-related experts, was conducted to form the indicator system framework. In-depth interviews with 15 experts from government departments were conducted to design the …

High Variability Of Iodine In Iodized Salt And Urine From Rural Households In Sidama Zone, Southern Ethiopia: A Cross-Sectional Study., Tafere Gebreegziabher Belay, Barbara J. Stoecker

All Faculty Scholarship for the College of Education and Professional Studies

Iodine is essential for the synthesis of thyroid hormones which regulate the metabolic processes of most cells and play important roles in human growth and development. Iodine deficiency has long been one of the most common nutritional problems in the world. Ethiopia, particularly the study population (Sidama) has a history of severe iodine deficiency. The purpose of the study was to assess urinary iodine concentration, level of goiter in mothers and school-age children and household salt iodine concentration in households 10 months after launch of the national salt iodization program. A cross-sectional study was conducted on a randomly selected sample …

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.

Older Adults Hospitalized For Pneumonia In The United States: Incidence, Epidemiology, And Outcomes., Forest W. Arnold, Andrea Reyes-Vega, Vidyulata Salunkhe, Stephen P. Furmanek, Christian Furman, Laura Morton, Anna Johan Faul, Pam Yankeelov, Julio A. Ramirez

Faculty and Staff Scholarship

OBJECTIVES: To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes. DESIGN: This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. SETTING: The study took place in all nine acute care hospitals for adults in Louisville, …

What's The Flap About Coronavirus?, V. Ramana Dhara

Journal of Health Ethics

This is a haiku about the vectors, modes of transmission and spread of SARS, MERS, and SARS-CoV-2