International Public Health Commons^™

Transforming Health Professions' Education Through In-Country Collaboration: Examining The Consortia Among African Medical Schools Catalyzed By The Medical Education Partnership Initiative., Zohray M. Talib, Elsie Kiguli-Malwadde, Hannah Wohltjen, Miliard Derbew, Yakub Mulla, David Olaleye, Nelson Sewankambo

Health Policy and Management Faculty Publications

BACKGROUND: African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning.

METHODS: Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These …

Indoor Particulate Matter Concentration, Water Boiling Time, And Fuel Use Of Selected Alternative Cookstoves In A Home-Like Setting In Rural Nepal, Kristen D. Ojo, Sutyajeet I. Soneja, Carolyn G. Scrafford, Subarna K. Khatry, Steven C. Leclerq, William Checkley, Joanne Katz, Patrick N. Breysse, James M. Tielsch

Global Health Faculty Publications

Alternative cookstoves are designed to improve biomass fuel combustion efficiency to reduce the amount of fuel used and lower emission of air pollutants. The Nepal Cookstove Trial (NCT) studies effects of alternative cookstoves on family health. Our study measured indoor particulate matter concentration (PM2.5), boiling time, and fuel use of cookstoves during a water-boiling test in a house-like setting in rural Nepal. Study I was designed to select a stove to be used in the NCT; Study II evaluated stoves used in the NCT. In Study I, mean indoor PM2.5 using wood fuel was 4584 μg/m3 , 1657 μg/m3 , …

A Global Map Of Hemispheric Influenza Vaccine Recommendations Based On Local Patterns Of Viral Circulation, Wladimir J. Alonso, Christine Yu, Cecile Viboud, Stephanie A. Richard, Cynthia Schuck-Paim, Lone Simonsen, Wyller A. Mello, Mark A. Miller

Global Health Faculty Publications

Both the Northern and the Southern Hemisphere annual WHO influenza vaccine recommendations are designed to ensure vaccine delivery before the winter-time peak of viral circulation in each hemisphere. However, influenza seasonal patterns are highly diverse in tropical countries and may be out of phase with the WHO recommendations for their respective hemisphere. We modelled the peak timing of influenza activity for 125 countries using laboratory-based surveillance data from the WHO’s FLUNET database and compared it with the influenza hemispheric recommendations in place. Influenza vaccine recommendations for respectively 25% and 39% of the Northern and Southern Hemisphere countries were out of …

How Can We Better Evaluate Complex Global Health Initiatives? Reflections From The January 2014 Institute Of Medicine Workshop., Sangeeta Mookherji, Kate Meck

Global Health Faculty Publications

An IOM workshop on evaluation design drew on recent evaluations of 4 complex initiatives (PEPFAR; the Global Fund to Fight AIDS, TB and Malaria; the President’s Malaria Initiative; and the Affordable Medicines Facility-malaria). Key components for good evaluations: (1) a robust theory of change to understand how and why programs should work; (2) use of multiple analytic methods; and (3) triangulation of evidence to validate and deepen understanding of results as well as synthesis of findings to identify lessons for scale-up or broader application.

How Can We Better Evaluate Complex Global Health Initiatives? Reflections From The January 2014 Institute Of Medicine Workshop., Sangeeta Mookherji, Kate Meck

Global Health Faculty Publications

An IOM workshop on evaluation design drew on recent evaluations of 4 complex initiatives (PEPFAR; the Global Fund to Fight AIDS, TB and Malaria; the President’s Malaria Initiative; and the Affordable Medicines Facility-malaria). Key components for good evaluations: (1) a robust theory of change to understand how and why programs should work; (2) use of multiple analytic methods; and (3) triangulation of evidence to validate and deepen understanding of results as well as synthesis of findings to identify lessons for scale-up or broader application.

Prevalence And Predictors Of Pap Smear Cervical Epithelial Cell Abnormality Among Hiv-Positive And Negative Women Attending Gynecological Examination In Cervical Cancer Screening Center At Debre Markos Referral Hospital, East Gojjam, Northwest Ethiopia, Melkamu Getinet, Baye Gelaw, Abinet Sisay, Eiman Mahmoud, Abate Assefa

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Background: Cervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Simultaneous human papillomavirus and human immunodeficiency virus (HIV) infection increases cervical cancer. Data on the prevalence and predictors of ECA among women in Ethiopia is limited. Hence, we aimed to determine the prevalence and associated factors of ECA among women.

Methods: A comparative cross-sectional study was conducted among HIV+ and HIV- women attending gynecological examination in cervical cancer screening center at the Debre …

Impact Of On-Site Training Of Neonatal Resuscitation Techniques In Shirati District Hospitals: Does On-Site Training Improve Knowledge, Attitude, And Practices?, Trista Fuchs, Yasmin Nibbe, Eiman Mahmoud

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Program/Project Purpose: In Tanzania, early neonatal morality remains high despite the county’s efforts towards improving health indicators. It’s estimated that birth asphyxia is involved in up to 30% of early neonatal deaths in developing countries, and is associated with high neurological morbidity for those who survive. Early interventions targeting birth asphyxia were not successful; likely due to low national priority, limited resources, and targeting limited types of providers. Helping Babies Breath (HBB) is an evidence-based neonatal resuscitation program designed for resource- limited settings. The program follows a basic intervention approach which emphasizes the importance of skilled attendants at every …

Trends In Hiv Prevalence, Sexual And Health Seeking Behaviors, And Hiv-Related Discrimination Among Nigerian Youth, Population Council

HIV and AIDS

Nigeria, home to over 170 million people, has a disproportionately heavy youth population of 32 percent whose well-being is intricately tied to the country’s prospects for sustainable development. Nigeria has an HIV prevalence of 3.4 percent, the second highest number of infections in the world. In 2013, it was estimated that 160,000 adolescents in Nigeria were living with HIV. Although Nigeria has developed a national HIV strategic plan that forms a basis for the HIV response, national AIDS and related policies contain few youth-centered provisions. Overall, the national strategic plan targets youth as part of the general population. To fill …

Do Clinical Decision-Support Reminders For Medical Providers Improve Isoniazid Prescription Rates Among Hiv-Positive Adults?, Eric P. Green, Caricia Catalani, Aggrey Keny, Lameck Diero, Charity Ndwiga, Dennis Israelski, Paul Biondich

HIV and AIDS

People living with HIV (PLHIV) are at increased risk of developing active tuberculosis (TB) and dying from TB. Isoniazid preventive therapy (IPT) can prevent this, but only a small fraction of HIV-positive individuals are on IPT. Previous research suggests that clinical decision support systems (CDSS)—electronic systems that use existing patient data and established algorithms to generate alerts, reminders, or recommendations intended to aid clinical decision-making—have the potential to improve provider adherence to diagnostic and treatment guidelines. Researchers conducted a cluster randomized controlled trial of a new CDSS intervention for TB screening, prevention, and treatment in a high HIV and TB …

A Secondary Analysis Of Retention Across The Pmtct Cascade In Selected Countries: Rwanda, Malawi, Kenya, And Swaziland, Godfrey Woelk, Aida Y. Berhan, Kwashie Kudiabor, Martha Mukaminega, John On'gech, Epiphanie Nyirabahizi, Caspian Chouraya, David Kimosop, Dieudonne Ndatimana, Mafayo Phiri, Heather Hoffman

HIV and AIDS

There is global consensus that transmission of HIV from mother to child can be eliminated. The Global Task Team, co-chaired by UNAIDS and the US Office of the Global AIDS Coordinator, has developed a global framework with the goal of eliminating new HIV infections among children (transmission rate of less than 5 percent) by 2015. Reaching the goal depends on optimal execution of each step in a complex cascade of activities, including testing and counseling for HIV, early attendance for antenatal care to optimize antiretroviral prophylaxis for prevention of mother-to-child transmission (PMTCT), adherence to the drugs, CD4 count testing, and, …

Addressing Mental Health Disorders And Hiv Vulnerability Of Marginalized Adolescents In Addis Ababa, Ethiopia, Nrupa Jani, Lung Vu, Sam Kalibala, Gebeyehu Mekonnen, Kay Lynn

HIV and AIDS

Ethiopia is experiencing an increasingly urban, female-centered HIV epidemic alongside a rise in rural migration of adolescents to Addis Ababa. Often these migrants are confronted by social challenges such as lack of education, inadequate housing, unstable employment conditions, and physical and sexual abuse. These difficult living circumstances contribute to psychological and mental health problems among these adolescents, potentially putting them at greater risk of acquiring HIV. However, knowledge about how targeted mental health interventions can impact HIV-related outcomes worldwide, and in Ethiopia, remains limited. The goal of this study was to pilot test a strategy for addressing mental health problems, …

Sexual And Reproductive Health And Rights Among Young People Living With Hiv In Uganda: Findings From The Link Up Baseline Survey, Population Council

HIV and AIDS

An estimated 3.7 percent of young people aged 15–24 years are living with HIV in Uganda, and face unique challenges in navigating a wide array of social, health, and developmental challenges as they transition to adulthood. Like all young people, those who live with HIV are starting to learn about their sexuality, often beginning to have intimate relationships or marry. In addition, they confront a myriad of complex issues associated with HIV status disclosure, initiation of and adherence to antiretroviral therapy, and deeply entrenched HIV-related stigma and discrimination. Young women bear a disproportionate share of this burden. Compared with men …

Sexual Health And Hiv Risk Behaviors Of Men Who Have Sex With Men In Myanmar—Baseline Findings From Link Up, Population Council, Burnet Institute

HIV and AIDS

In 2013, an estimated 189,000 people were living with HIV in Myanmar. The overall adult HIV prevalence is estimated to be around 0.5 percent, but key populations such as men who have sex with men (MSM) bear a disproportionate disease burden. According to national estimates, HIV prevalence among MSM is 20 times higher than in the general population, at 10 percent. Effective, targeted, innovative, and culturally appropriate interventions that have been shown to significantly reduce high-risk sexual behaviors among MSM are needed to reduce the HIV burden among this population. In Myanmar, as part of the Link Up project, Alliance …

Annotated Bibliography Of Nigerian Youth-Focused Hiv And Sexual And Reproductive Health Project Publications (Grey Literature), Population Council

HIV and AIDS

Adolescents and young adults (15–24 years) constitute about one-third of the total population of Nigeria, and their well-being is intricately tied to the country’s prospects for sustainable development. The HIV prevalence among 15–24-year-old men and women is 2.5 percent and 3.1 percent, respectively. In 2013, it was estimated that 160,000 adolescents (aged 10–19) in Nigeria were living with HIV. Rightfully, an increasing focus is being paid to the sexual and reproductive health (SRH) of young Nigerians, however it is essential that the dialogue and interventions around young people’s SRH be informed and take into account the body of evidence available …

Arv-Based Hiv Prevention For Women: State Of The Science And Considerations For Implementation In Zimbabwe. Report From A Provider Workshop, Population Council

HIV and AIDS

This report provides an overview of the presentations and discussions emerging from a Provider Workshop on ARV-Based HIV Prevention for Women: State of the Science and Considerations for Implementation in Zimbabwe convened by the Ministry of Health and Child Care and the Population Council in Harare in May 2014. The workshop in Zimbabwe is part of a broader global process to begin paving the path for microbicides introduction while awaiting the results of the ongoing confirmatory trial (FACTS 001) of tenofovir gel in South Africa. USAID is spearheading a global effort toward a “Shared Vision and Strategic Plan for Microbicide …

Introducing Antiretroviral (Arv)-Based Prevention Products For Women: A Guide To Strategic Decisionmaking And Planning, Population Council

HIV and AIDS

As evidence mounts that antiretrovirals (ARVs) are effective for HIV prevention, policymakers and program managers will need to determine whether and how best to introduce specific products into health care systems. Determining the most appropriate users within a particular country will depend on the overall context, the nature of the HIV epidemic within the country, and the opportunities available to reach and serve HIV-negative women with ARV-based prevention products and services. This toolkit was developed by the Population Council for use by governments, organizations, and donors who are in a position to support or add new HIV-prevention products into programs. …

Reach: Randomized Evaluation Of Hiv/Fp Service Models, Paul C. Hewett, Mutinta Nalubamba, Fiammetta Bozzani, Mardieh Dennis, Jean Digitale, Lung Vu, Eileen Yam, Mary Nambao

HIV and AIDS

The REacH (Randomized Evaluation of HIV/FP Service Models) project compares health service uptake of two models for HIV prevention and family planning service linkage and integration. This report details results which indicate that the enhanced client add-on service referral and follow-up arm with and without the escort increased the uptake of HIV testing and counseling services among women who had entered at family planning care entry points. The effect of the intervention was greater in the shorter term, improving uptake within six weeks, but nonetheless remained important through six months. The results indicate that the intervention can increase the numbers …

Burundi Program Implementation Workshop, 3–5 June 2014: Link Up Meeting Report, Population Council, Alliance Burundaise Contre Le Sida

HIV and AIDS

Link Up is a global consortium of international and local nongovernmental organizations led by the International HIV/AIDS Alliance. Link Up aimed to improve the sexual and reproductive health and rights of young people in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda who are living with HIV or are affected by the HIV pandemic. At a workshop held in Burundi, 3–5 June 2014, the Population Council, Alliance Burundaise contre le SIDA, and local partners in Burundi identified successful activities, highlighted important challenges and best practices, and found innovative ways to improve Link Up programming. This document contains a selection of the most …

Sexual And Reproductive Health Among Young Female Sex Workers In Bangladesh Brothels—Baseline Findings From Link Up, Population Council

HIV and AIDS

Link Up is a global consortium of international and local nongovernmental organizations led by the International HIV/AIDS Alliance. Link Up aimed to improve the sexual and reproductive health and rights of young people in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda who are living with HIV or are affected by the HIV pandemic. Consortium members PIACT Bangladesh and Marie Stopes Bangladesh implemented a brothel-based program for female sex workers to address sexual and reproductive health and rights. Working in eight brothels in seven districts, trained female sex worker peer educators provided face-to-face education, including referrals to on-site and off-site health care …

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Belize 2011, Population Council, Unicef Belize

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Belize 2011” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

Annotated Bibliography Of Peer-Reviewed Literature Related To The Sexual And Reproductive Health Of Young People In Nigeria (2000-2014), Population Council

HIV and AIDS

The 1994 International Conference on Population and Development’s Programme of Action identified eight components (safe motherhood, gender equity, family planning information and services, prevention and treatment of infertility and sexual dysfunction in both men and women, prevention and management of the complications of abortion, prevention and treatment of reproductive tract infections and sexually transmitted infections including HIV, elimination of harmful customary practices, and screening for reproductive tract cancers—prostate, breast, and cervix) of sexual and reproductive health (SRH) for all persons including young people aged 10–24. This annotated bibliography is organized with the eight components as its guiding framework with several …

Experiences With Pregnancy Among Female Sex Workers In Ethiopia: A Link Up Exploratory Study, Population Council, Miz-Hasab Research Center, Organization For Social Services For Aids

HIV and AIDS

In Ethiopia, it is illegal to operate a brothel or procure sex workers as a commercial activity, but the sale of sex by women is not prohibited by law. Research suggests that the number of Ethiopian female sex workers is growing, with younger women and girls increasingly entering the sex trade. Public health programs and policies typically have emphasized HIV prevention in this vulnerable population. A 2014 study of 3,882 Ethiopian female sex workers found that HIV prevalence in the 10 study sites ranged from 15–33 percent, compared to national prevalence of 1.9 percent among women. Furthermore, since most female …

The Impact Of Population, Health, And Environment Projects: A Synthesis Of Evidence, Rachel Winnik Yavinsky, Carolyn Lamere, Kristen P. Patterson, Jason Bremner

Reproductive Health

This working paper synthesizes the existing research and results from projects that integrate family planning with environment, livelihoods, natural-resource management, and other non-health development sectors. The report synthesizes the published and gray literature on current and past integrated projects and the experiences of implementers to generate a summary of the state of knowledge on integrated family planning and environment projects. Specifically, this synthesis documents what is being measured by integrated projects, the proven benefits of integration, and gaps in the evidence base. Based on this analysis, the synthesis highlights and discusses successes and challenges for documenting the impact of integrating …

Low Use And High Discontinuation Of Modern Contraceptives In Pakistan: Reasons And Policy Recommendations, Population Council

Reproductive Health

According to the latest Pakistan Demographic and Health Survey, 20 percent of married women of reproductive age have unmet need for contraception. Moreover, the country’s contraceptive prevalence rate (CPR), for modern and traditional methods combined, is only 35 percent—one of the lowest CPRs in the region. In addition to the problem of nonuse, the country is finding it difficult to keep current contraceptive users onboard: compared to other developing countries, Pakistan has the highest rate of discontinuation of contraceptive use. Thus, while there has been an overall increase in the use of contraceptives—modern and traditional—there is a large difference between …

The Effect Of Integrating Hiv Services On Quality Of Postnatal Care, Integra Initiative

Reproductive Health

Addressing the postnatal needs of new mothers is a neglected area of care throughout sub-Saharan Africa. Unintended pregnancies during the first 12 months following delivery, and vertical transmission of HIV during labor and delivery, are some of the challenges faced by women during the extended postpartum period. Many women want to delay or avoid another pregnancy, but are not using a modern contraceptive method. Few developing countries ensure that mothers and newborns are assessed early and monitored during the initial six-week period as recommended by WHO, which contributes to discontinuity of services received during pregnancy and delivery and limits linkages …

Expanding Young People's Access To Integrated Services In Malawi, Integra Initiative

Reproductive Health

In sub-Saharan Africa, uptake of sexual and reproductive health (SRH) services among young people remains low, placing millions of young people at risk of poor reproductive health outcomes and sexually transmitted infections, including HIV. The “Steps to Integration” series provides a guide on how to integrate HIV and SRH services based on findings from the Integra Initiative, managed by the International Planned Parenthood Federation in partnership with the London School of Hygiene & Tropical Medicine and the Population Council. Issue 7 of the series focuses on expanding young people’s access to integrated services in Malawi. Conclusions include: improving the quality …

Reducing Maternal And Child Mortality In Punjab: The Untapped Potential Of Family Planning, Zeba Sathar, Maqsood Sadiq, Seemin Ashfaq

Reproductive Health

Family planning (FP) is recognized as a necessary tool for faster fertility decline leading to accelerated economic development. However, its unique and potent role in preserving mother and child health is less well understood. This Population Council/Evidence Project policy brief explains why FP must be prioritized in Punjab’s health strategy as a key intervention for reducing maternal, infant, and under-five mortality in the province. By fulfilling the existing unmet need for birth spacing and limiting, it is possible to prevent 45 percent of maternal deaths, 26 percent of infant deaths, and 76 percent of young child deaths. FP’s wider health …

Diagnosing An International Health Crisis: A Structural Exploration Of Ebola 2014, Maddison Zayn Jansen

Honors Program Theses

The Ebola crisis of 2014, though concentrated most heavily in three small countries in western Africa, awoke the international community to its lack of effective health crisis infrastructure. As the disease rocked the globe, multinational groups scrambled to help those directly affected and protect the overwhelming majority of people not directly affected. Most preventative measures failed, and pre-existing initiatives to stem the flow of the disease only served to open the floodgates more. After careful examination of the literature surrounding medical, cultural, financial, national, and global circumstances enabling Ebola to flourish, as well as applying individual analysis and examination, it …

Microbiological Contamination Of Mobile Phones Of Clinicians In Intensive Care Units And Neonatal Care Units In Public Hospitals In Kuwait, Mohammed Heyba, Mohammad Ismaiel, Abdulrahman Alotaibi, Mohamed Mahmoud, Hussain Baqer, Ali Safar, Noura Al-Sweih, Abdullah Al-Taiar

Community & Environmental Health Faculty Publications

Background: The objective of this study was to explore the prevalence of microbiological contamination of mobile phones that belong to clinicians in intensive care units (ICUs), pediatric intensive care units (PICUs), and neonatal care units (NCUs) in all public secondary care hospitals in Kuwait. The study also aimed to describe mobile phones disinfection practices as well as factors associated with mobile phone contamination.

Methods: This is a cross-sectional study that included all clinicians with mobile phones in ICUs, PICUs, and NCUs in all secondary care hospitals in Kuwait. Samples for culture were collected from mobile phones and transported for microbiological …

Learning From Women About Hiv Risk, Hiv Testing Behaviors, And Prevention Practices In Mpumalanga, South Africa: A Descriptive Study To Inform Microbicides Introduction, Martha Brady, Saiqa Mullick, Barbara Friedland, Marlena Gehret Plagianos, Linda Du Plessis, Thabiso Mango

HIV and AIDS

The provision of any new prevention product in clinical trial settings is often vastly different from implementation in “real life” public sector settings. In addition, use of antiretrovirals (ARV), such as tenofovir gel, for pre-exposure prophylaxis requires regular HIV testing to ensure users are uninfected before initiating and continuing product use. Therefore, before any ARV-based prevention product can be introduced to women, information is needed on HIV testing practices, how best to integrate products into existing primary health care systems, and women’s risk perception and health-seeking behaviors. The Population Council, in partnership with Solutions IPPT, conducted a study to learn …