Demography, Population, and Ecology Commons^™

Expanding Services To Detect, Manage, And Prevent Pre-Eclampsia And Eclampsia In Tando Allahyar District Of Sindh Province, Pakistan, Ali M. Mir, Irfan Masood, Mumraiz Khan, Sharif M.I. Hossain, Tracy Mcclair, Pooja Sripad, Charlotte E. Warren

Reproductive Health

This endline report documents a USAID-supported implementation research project carried out by the Population Council in one district in Sindh province, as part of the global—Bangladesh, Ethiopia, Kenya, Nigeria, Pakistan—Ending Eclampsia initiative. This project assessed community midwives’ (CMWs) abilities to screen and detect pre-eclampsia/severe pre-eclampsia/eclampsia (PE/SPE/E) in pregnant and postnatal women and provide a loading dose of magnesium sulfate (MgSO4) to clients suffering from SPE/E and referrals to facilities for further management. This study also explored opportunities to enhance collaboration between CMWs and lady health workers (LHWs), encouraging LHWs to refer pregnant women for group antenatal care (ANC) and postnatal …

Post-Intervention Analysis Of Pre-Eclampsia And Eclampsia In Three Nigerian States, Salisu Mohammed Ishaku, Emmanuel Nwala, Gloria Adoyi, Charles Nwigwe, Solomon Kongyamba, Udochisom Anaba, Caroline Johnson, Karen Kirk, Pooja Sripad, Charlotte E. Warren

Reproductive Health

In the last three decades, global maternal mortality has decreased by almost 45 percent, but approximately 830 women still die daily from largely preventable pregnancy complications. Since 2015, the Ending Eclampsia project, with support from USAID, has been working to expand proven, underutilized interventions and commodities for pre-eclampsia/eclampsia (PE/E) prevention, early detection, and treatment, and to strengthen global partnerships for care of hypertensive disorders in pregnancy (HDP), of which PE/E are the severest forms. A systematic review of the literature identifies a number of articles reporting PE/E burdens within set populations, common risk factors, adverse outcomes, and mortality rates, but …

Assessing Quality Of Care And Outcomes For Women And Their Infants In Nigeria After Pregnancies Complicated By Hypertensive Disorders, Salisu Mohammed Ishaku, Gloria Adoyi, Innocent Agbo, Karen Kirk, Pooja Sripad, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy (HDPs) are the leading cause of maternal mortality in Nigeria—now killing more women than postpartum hemorrhage. Various factors, including lack of capacity among lower-level health-care providers to detect, manage, and refer complications, have been indicated as reasons for most of these deaths. A landscape analysis of pre-eclampsia/eclampsia (PE/E) in Nigeria identified a lack of further information after delivery about the women who experienced HDPs. In this study, the Ending Eclampsia project recruited women with HDPs around the time of childbirth, and prospectively followed them for up to one year postpartum. The study evaluated the care these …

Hypertensive Disorders In Pregnancy: Assessing Postnatal Quality Of Care And Outcomes For Women And Their Infants In Bangladesh, Sharif M.I. Hossain, Kanij Sultana, Salma Rouf, Rabeya Akter, Shongkour Roy, Sumaiya Anwar, Karen Kirk, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy (HDPs) are the second leading cause of maternal mortality in Bangladesh, responsible for 24 percent of maternal deaths. Various factors, such as lack of health-care provider capacities for detecting, preventing, and managing pre-eclampsia and eclampsia (PE/E), late referrals, late (or lack of) antenatal care (ANC), and poor awareness of PE/E, are factors in most of these deaths. While some information was available on the prenatal and postnatal periods, an evidence gap existed in information after delivery through the first year postnatal, and beyond. In this prospective cohort study, the Ending Eclampsia project recruited married women ages …

Assessing The Feasibility Of Primary Health Care Provider Prescription Of Anti-Hypertensive Medication To Pregnant Women In Bangladesh, Sharif M.I. Hossain, Kanij Sultana, Shongkour Roy, Pooja Sripad, Charlotte E. Warren

Reproductive Health

Hypertensive disorders of pregnancy (HDPs)—which are major contributors of maternal and newborn mortality, morbidity, and disability—are preventable. About 24 percent of maternal deaths in Bangladesh each year are due to pre-eclampsia and eclampsia (PE/E). A known cause of death in women with PE/E is cerebrovascular accident, which occurs due to rapidly increasing blood pressure (BP). Elevated BP associated with pregnancy should be detected and appropriately managed before onset of convulsions (eclampsia) and other life-threatening complications. For women presenting with severe PE/E, magnesium sulphate (MgSO4) is the recommended drug for convulsion management. Anti-hypertensive medicines are also recommended for control of high …

Implementing Components Of The Phc For Pe/E Model In Pakistan: A Cost Analysis, Ali M. Mir, Mumraiz Khan, Pooja Sripad, Sara Chace Dwyer

Reproductive Health

Pre-eclampsia/Eclampsia (PE/E) is the third leading cause of maternal mortality in Pakistan. Women with PE are at increased risk for organ damage or failure, pre-term birth, loss of pregnancy, and stroke. PE can progress to eclampsia, which is characterized by seizures, and may be associated with kidney and liver damage, as well as maternal death. The risks of PE/E can be mitigated with regular screening during antenatal care and the postnatal period. Regular monitoring of PE can lessen progression to severe PE/E, and severe PE/E can be managed through administration of magnesium sulfate and antihypertensive drugs. Between 2016 and 2018, …

Meeting Report Of The International Conference On The Great Lakes Region's Regional Training Facility: Working With The Police Sector To Meet The Needs Of Sexual Violence Survivors In The Great Lakes Region, Nathan Byamukama, Chi-Chi Undie, Sharon Asiimwe, George Odwe, Nachela Chelwa, Harriet Birungi, Michael Mbizvo

Reproductive Health

For over a decade, the Population Council and its partners (the Africa Regional SGBV Network) have provided technical assistance and conducted research to strengthen the evidence base of sexual and gender-based violence (SGBV) programming in Africa’s East, Horn, and Great Lakes regions. Under the Africa Regional SGBV Network, the Council and partners developed and tested an intervention including police response to sexual violence survivors, with police provision of emergency contraception (EC) for survivors and referrals to health facilities. This model has been successfully tested in Zambia and Malawi. Studies reveal that EC provision by trained police to sexual violence survivors …

Storytelling And Policy Change In Africa's Great Lakes Region, Chi-Chi Undie, Nathan Byamukama, George Odwe, Nachela Chelwa, Harriet Birungi, Michael Mbizvo

Reproductive Health

In April 2019, the International Conference on the Great Lakes Region’s Regional Training Facility (ICGLR-RTF) organized a regional meeting entitled “Sensitization Meeting for Police Chiefs and National Reproductive Health Heads in the Great Lakes Region.” Held in Kigo, Uganda, the meeting brought together chiefs of police and heads of reproductive health departments (Ministries of Health) from nine ICGLR member states, namely: Burundi, Central African Republic, Democratic Republic of Congo, Kenya, Republic of Congo, South Sudan, Sudan, Uganda, and Zambia. The meeting was sponsored by the Population Council, Kenya. Sauti/VOICE Program Brief 2 describes the preamble to ICGLR-RTF’s meeting resolutions and …

Practice-Based Learning: Observations On One-Stop Centers In Refugee Settings, Chi-Chi Undie, Josephine Ngebeh, Jane Harriet Namwebya, Joanina Karugaba

Reproductive Health

One-Stop Centers’ (OSCs) have grown in popularity for responding to sexual and gender-based violence (SGBV) in the East, Horn, and Great Lakes regions of Africa. OSCs attempt to provide an integrated, multisectoral response to SGBV survivors’ needs in one location. In resource-constrained settings, the most common services offered at OSCs include health care, psycho-social support, police and judicial services, as well as social support. Studies demonstrate that health-facility-based OSCs that are owned and run by health-facility staff are more effective than NGO-run OSCs in achieving the broadest range of desired health and legal outcomes for SGBV survivors. In collaboration with …

Mise En Œuvre Des Composantes Du Modèle Ssp Pour La Pe / E Au Nigéria : Une Analyse Des Coûts, Pooja Sripad, Sara Chace Dwyer, Gloria Adoyi

Reproductive Health

Entre 2016 et 2018, le Population Council, en partenariat avec les Ministères de la Santé fédéraux et des États du Nigéria, a mis en œuvre une intervention visant à lutter contre la pré-éclampsie/éclampsie (PE/E) dans trois États: Ebonyi, Cross River et Kogi. C’était dans le cadre du projet Ending Eclampsia, un investissement quinquennal de l'USAID qui a mis en œuvre des aspects du modèle de soins de santé primaires (SSP) pour le modèle PE/E au Bangladesh, au Nigéria et au Pakistan. L'intervention au Nigéria comprenait cinq composantes de SSP pour le modèle PE/E: 1) le partage des tâches avec des …

Prévention Du Mariage D’Enfants Dans La Région De L’Est, Burkina Faso, Gisele Kaboré, Julien Ouedraogo, Annabel Erulkar, Sara Chace Dwyer

Reproductive Health

En collaboration avec la Direction Provinciale de la Femme, de la Solidarité Nationale et de la Famille du Burkina Faso et des partenaires communautaires de la région orientale du Burkina Faso, le Projet Evidence a mis à l'échelle des approches éprouvées pour retarder le mariage des jeunes filles en sensibilisant aux effets négatifs du mariage précoce. Les approches étaient basées sur des preuves produites dans une étude menée par le Population Council de 2013 à 2016 dans la province de Léraba. Dans cette étude, le report de l'âge du mariage pour les filles de 15 à 17 ans et la …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Nigeria, Pooja Sripad, 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 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 …

Practice-Based Learning: Integrating Sgbv Screening Into Health Facilities In Refugee Contexts, Chi-Chi Undie, Josephine Ngebeh, Joanina Karugaba, Harriet Birungi, Michael Mbizvo

Reproductive Health

Sexual and gender-based violence (SGBV) “screening” refers to the standardized assessment of clients for SGBV incidents, regardless of reasons for presenting at a health facility. This practice has been shown to be feasible and effective in various countries and contexts in the East and Southern African region, resulting in proactive identification of female survivors, and their successful referrals for comprehensive SGBV care. In the last decade, health facilities in the region have been increasingly eager to incorporate such screening within the normal protocols of their health-care providers. In collaboration with the Population Council-led Africa Regional SGBV Network, the UNHCR East, …

Child Obesity And The Interaction Of Family And Neighborhood Socioeconomic Context, Ashley W. Kranjac, Justin T. Denney, Rachel T. Kimbro, Brady S. Moffett, Keila N. Lopez

Sociology Faculty Articles and Research

The literature on neighborhoods and child obesity links contextual conditions to risk, assuming that if place matters, it matters in a similar way for everyone in those places. We explore the extent to which distinctive neighborhood types give rise to social patterning that produces variation in the odds of child obesity. We leverage geocoded electronic medical records for a diverse sample of over 135,000 children aged 2 to 12 and latent profile modeling to characterize places into distinctive neighborhood contexts. Multilevel models with cross-level interactions between neighborhood type and family socioeconomic standing (SES) reveal that children with different SES, but …

La Comunicación Lingüística En Español Y Sus Barreras En El Sistema De Salud De Los Estados Unidos, David Sánchez-Jiménez

Publications and Research

La enseñanza del español con fines médicos en los Estados Unidos ha experimentado un crecimiento exponencial en las dos últimas décadas. Sin embargo, los pacientes de origen hispano se encuentran desprotegidos ante las barreras lingüísticas que impone el sistema de salud estadounidense en muchos contextos monolingües y bilingües. Esta investigación descriptiva muestra como, por un lado, los malentendidos producidos por la comunicación ineficiente desarrollada por intérpretes e intermediarios (familiares, enfermeras con conocimientos de español, facultativos con una preparación lingüística deficiente, etc.) tienen serias repercusiones para la salud en el tratamiento de los casos. Por otro lado, el estudio da cuenta …

Neighborhood And Social Environmental Influences On Child Chronic Disease Prevalence, Ashley Wendell Kranjac, Justin T. Denney, Rachel T. Kimbro, Brady S. Moffett, Keila N. Lopez

Sociology Faculty Articles and Research

We investigate how distinct residential environments uniquely influence chronic child disease. Aggregating over 200,000 pediatric geocoded medical records to the census tract of residence and linking them to neighborhood-level measures, we use multiple data analysis techniques to assess how heterogeneous exposures of social and environmental neighborhood conditions influence an index of child chronic disease (CCD) prevalence for the neighborhood. We find there is a graded relationship between degree of overall neighborhood disadvantage and children’s chronic disease such that the highest neighborhood CCD scores reside in communities with the highest concentrated disadvantage. Finally, results show that higher levels of neighborhood concentrated …

Measuring Women's Empowerment In Sub-Saharan Africa: Exploratory And Confirmatory Factor Analyses Of The Demographic And Health Surveys, Ibitola O. Asaolu, Halimatou Alaofè, Jayleen K. L. Gunn, Akosua K. Adu, Amanda J. Monroy, John E. Ehiri, Mary H. Hayden, Kacey C. Ernst

Epidemiology and Environmental Health Faculty Publications

Background: Women's status and empowerment influence health, nutrition, and socioeconomic status of women and their children. Despite its benefits, however, research on women's empowerment in Sub-Saharan Africa (SSA) is limited in scope and geography. Empowerment is variably defined and data for comparison across regions is often limited. The objective of the current study was to identify domains of empowerment from a widely available data source, Demographic and Health Surveys, across multiple regions in SSA.

Methods: Demographic and Health Surveys from nineteen countries representing four African regions were used for the analysis. A total of 26 indicators across different dimensions (economic, …

Book Review: Surrogacy: A Human Rights Violation By Renate Klein, Sheela Saravanan

Dignity: A Journal of Analysis of Exploitation and Violence

No abstract provided.

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …

Healthcare Coverage In The United States And New York Metropolitan Area, 2009 - 2015, Andrew S. Alger

Center for Latin American, Caribbean, and Latino Studies

Introduction: This study examines trends regarding health insurance coverage in the United States along lines of sex, race/ethnicity, place of birth, and poverty status between 2009 and 2015.

Methods: This study uses the American Community Survey PUMS (Public User Microdata Series) for the years 2009, 2011, 2013, and 2015. These datasets were downloaded from the IPUMS USA website hosted by the University of Minnesota. The variables used in the study describe these populations in terms of sex, the four major race/ethnic groups (non-Hispanic white, non-Hispanic black, Latino, and Asian), being born either within the United States or abroad, and being …

Exploring Barriers And Opportunities For Pre-Eclampsia And Eclampsia Prevention And Management In Ethiopia, Pooja Sripad, Hussein Ismail, Amy Dempsey, Karen Kirk, Charlotte E. Warren

Reproductive Health

The Ending Eclampsia Project is a five-year cooperative agreement between the United States Agency for International Development (USAID) and the Population Council, in partnership with the Federal Ministry of Health Ethiopia, which seeks to expand access to quality underutilized interventions and commodities for the prevention and treatment of pre-eclampsia/eclampsia (PE/E). This report presents qualitative findings from formative research conducted to: 1) assess the policy and health systems environment related to PE/E prevention and management, 2) identify potential bottlenecks in the supply chain, 3) investigate PE/E knowledge, attitudes, and practices at policy, health system, and community levels, 4) describe the barriers …

Addressing Barriers To Quality Of Underutilized Commodities And Services For Prevention And Management Of Pre-Eclampsia And Eclampsia In Kenya, Charity Ndwiga, Pooja Sripad, Charlotte E. Warren

Reproductive Health

The Ending Eclampsia Project seeks to increase access to quality, underutilized interventions and commodities for the prevention, detection, and management of pre-eclampsia and eclampsia (PE/E), including promoting correct use of antihypertensive drugs and magnesium sulphate (MgSO4). This final report details the findings of a qualitative study that explored health system bottlenecks that prevent access to quality maternal and newborn health care in two Kenyan counties, Kakamega and Kitui, with a specific focus on PE/E. The study explored policy implementation gaps in Kenya’s newly devolved county government structure, to:1) assess the policy and health system environment for PE/E diagnosis, referral, and …

Retrospective Cohort Study: Clinical Presentation And Outcomes Of Pre-Eclampsia And Eclampsia At Kenyatta National Hospital, Nairobi, Kenya, Charity Ndwiga, Alfred Osoti, Pooja Sripad, George Odwe, Omondi Ogutu, Charlotte E. Warren

Reproductive Health

Pre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for …

Life Expectancies With Depression By Age Of Migration And Gender Among Older Mexican Americans, Catherine García, Marc A. Garcia, Chi-Tsun Chiu, Fernando I. Rivera, Mukaila Raji

Department of Sociology: Faculty Publications

Background and Objectives: Prior studies examining depression among older Mexican Americans suggest both women and immigrants are at higher risk of depressive symptomatology than males and U.S.-born Mexican Americans. We use data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine whether life expectancy with depression and without depression varies by nativity, age of migration, and gender.

Research Design and Methods: Sullivan-based life tables were used to estimate depression life expectancies among Mexican Americans aged 65 years and older residing in the Southwestern United States. Depression is based on the 20-item Center for Epidemiological Studies …

Moving Mountains : A Study Examining Long-Term Impacts Of Mountaintop Removal Coal Mining On Mortality In The Appalachian Region Using Geographic Information Sciences Techniques., James Howard Kent Pugh

Electronic Theses and Dissertations

Over the last hundred years, the Appalachian region has been dominated by the coal industry. It has also been and currently is one of the unhealthiest regions in the United States. Recent scholarship has examined the relationship between coal mining and health and mortality rates in the Appalachian region. The first study incorporates air quality and pollution data to examine if coal mining counties have higher levels of pollution and if this pollution contributes to mortality disadvantage. In the second study, I construct a population-based coal-exposure measure to better evaluate the relationship between coal mining and health I find that …

A Guide For Assessing Older Adults’ Needs On Maine Islands, Beatrice Byrne

Muskie School Capstones and Dissertations

This template may help Maine island communities identify older adults’ needs and island resources, in order to allow older adults to age in the island communities.

Three interviews with island health leaders, one community conversation with older islanders, and one pilot test provided information about what to include in the template.

The template includes a demographic survey, guides for conducting semi-structured interviews and group conversations with older adults and caregivers, a guide and worksheet for analyzing the data, a guide for assessing community resources, a guide for dissemination, and a list of additional resources.

Comprehensive Neighborhood Portraits And Child Asthma Disparities Introduction, Ashley W. Kranjac, Rachel T. Kimbro, Justin T. Denney, Kristin M. Osiecki, Brady S. Moffett, Keila N. Lopez

Sociology Faculty Articles and Research

Objectives Previous research has established links between child, family, and neighborhood disadvantages and child asthma. We add to this literature by first characterizing neighborhoods in Houston, TX by demographic, economic, and air quality characteristics to establish differences in pediatric asthma diagnoses across neighborhoods. Second, we identify the relative risk of social, economic, and environmental risk factors for child asthma diagnoses. Methods We geocoded and linked electronic pediatric medical records to neighborhood-level social and economic indicators. Using latent profile modeling techniques, we identified Advantaged, Middle-class, and Disadvantaged neighborhoods. We then used a modified version of the Blinder-Oaxaca regression decomposition method to …

Evaluation Of The Pepfar/Usaid Asibonisane Community Responses Program In Kwazulu-Natal, South Africa, Project Soar

HIV and AIDS

Few programs intended to improve HIV outcomes or modulate gender norms have been rigorously evaluated in South Africa’s informal settlements where nearly 400,000 people live in KwaZulu Natal province alone. There is limited evidence on how to implement large-scale HIV-prevention programming in these contexts. Project SOAR and partners are addressing these knowledge gaps by conducting an evaluation of the PEPFAR/USAID-funded Asibonisane Community Responses Program in South Africa. Specifically, the study will assess the effectiveness of this community-based HIV-prevention program in informal settlements throughout KwaZulu-Natal—one of four provinces where the program is being carried out. This study aims to influence the …

Private Sector Costing Of Voluntary Medical Male Circumcision In South Africa, Michel Tchuenche, Steven Forsythe

HIV and AIDS

In 2010, after voluntary medical male circumcision (VMMC) had been shown to be one of the most cost-effective strategies for preventing HIV infections, South Africa initiated a VMMC program with an ambitious target of performing 4.3 million circumcisions by 2016. However, because of a gap in knowledge concerning the overall cost of scaling up services, the South African National Department of Health requested that Project SOAR—Supporting Operational AIDS Research—conduct a private-sector costing of providing VMMC services in South Africa. The findings presented in this report provide a detailed investigation, through a comprehensive bottom-up approach, of the costs to private providers …

Stakeholder Considerations For Prep Introduction To Adolescent Girls And Young Women: Laying The Groundwork For Research Utilization In Tanzania, Population Council

HIV and AIDS

In collaboration with the Tanzania National AIDS Control Programme and CSK Research Solutions Ltd., the Population Council is conducting an implementation science research study in that country to build needed evidence to inform decisionmaking around oral pre-exposure prophylaxis (PrEP) introduction to adolescent girls and young women (AGYW) aged 15–24. The study uses quantitative and qualitative methods to gather data from AGYW, policymakers and other stakeholders, health providers, and AGYW’s parents and male partners to: assess their knowledge and attitudes toward oral PrEP; determine opportunities and approaches for providing PrEP; and identify potential facilitators and barriers to PrEP introduction and use. …