Medicine and Health Commons^™

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, …

Lifetime Racism And Blood Pressure Changes During Pregnancy: Implications For Fetal Growth, Clayton J. Hilmert, Tyan Parker Dominguez, Christine Dunkel Schetter, Sindhu K. Srinivas, Laura M. Glynn, Calvin J. Hobel, Curt A. Sandman

Psychology Faculty Articles and Research

Objective: Research suggests that exposure to racism partially explains why African American women are 2 to 3 times more likely to deliver low birth weight and preterm infants. However, the physiological pathways by which racism exerts these effects are unclear. This study examined how lifetime exposure to racism, in combination with maternal blood pressure changes during pregnancy, was associated with fetal growth. Methods: African American pregnant women (n = 39) reported exposure to childhood and adulthood racism in several life domains (e.g., at school, at work), which were experienced directly or indirectly, meaning vicariously experienced when someone …

The Characteristics Of Women Seeking Funding From The Dc Abortion Fund, Karin Elizabeth Bleeg

GW Research Days 2013

Objectives: To determine whether the population DCAF serves, based on current research, are those most in need of its financial services. Describe the population that DCAF is supports by age, race and ethnicity, poverty, educational attainment, union status, contraceptive method used, referral source, and number of prior pregnancies.

Methods: An adapted version of The Guttmacher Institute's National Patient Survey will be used to collect data from women who contact DCAF for financial assistance for their abortion (n=150). The data will be collected for one month and then analyzed in SPSS.

Results: Between January and March 2013 approximately 400 women contacted …

Kalkidan ('Promise'): Addressing Marital Transmission Of Hiv In Ethiopia, Banchiamlack Dessalegn, Annabel Erulkar

Poverty, Gender, and Youth

This program brief describes a Population Council initiative in three low-income areas of Ethiopia. Kalkidan (Amharic for “Promise”) is a three-year program designed to increase discussion and information-sharing on HIV and related topics between marital partners; to promote HIV prevention and health service utilization within marriage, including prevention of mother-to-child transmission (PMTCT) of HIV; and to build husbands’ support of their wives, as well as investment in their health and that of their children. Kalkidan recruits and trains community-based mentors to lead parallel discussion groups of husbands and wives, who periodically come together for joint sessions. The Population Council is …

Adverse Maternal Outcomes For Women With Different Health Insurance Statuses In Nevada, Jay J. Shen, Hong Wei

Nevada Journal of Public Health

Objective. Nevada women with unfavorable health insurance status may face greater barriers than women in the rest of the nation, since the development of healthcare infrastructure in Nevada is running behind population growth. This study examines the relationship between health insurance status and adverse maternal outcomes in Nevada.

Methods. Hospital discharge information of 33,149 women aged 13 or older who delivered in 2004 was abstracted from the 2004 State Inpatient Data for Nevada. A total of 13 measures of complications associated with pregnancy were identified, including preterm labor, hypertensive disorders of pregnancy, gestational diabetes, ante-partum hemorrhage, membrane disorders, cesarean section, …

Blood Lead Levels In Nevada Children, Arthur F. Di Salvo, Terry R. Hall

Nevada Journal of Public Health

The purpose of this study was to assess the prevalence of plumbism in children one to six years of age in Nevada. During a four-year period from 1992 – 1996, 10,700 children were screened for evidence of blood lead intoxication. The capillary specimens were analyzed by atomic absorption spectrometry. All children with a lead level => 10 ug/L were retested using venous blood. Ninety three percent of the children had blood lead levels < 10 µg/dL

Adverse Maternal Outcomes In Nevada: Does Asthma Matter?, Jay J. Shen, Hong Wei, Robin Mukalian

Nevada Journal of Public Health

Objective. Asthma is a common clinical complication of pregnancy and women with asthma are at greater risk of having complications. This study compared adverse maternal outcomes between women with asthma and women without asthma in Nevada.

Methods. A total of 64,664 hospital discharges of delivery were abstracted from the Nevada 2003-2004 hospital discharges and thirteen adverse maternal outcomes were examined. Logistic regression was applied to compare the maternal outcomes between women with and without asthma.

Results. Women with asthma were more likely to have pre-eclampsia (OR [CI] 1.73 [1.13, 2.65]), transient hypertension of pregnancy (OR [CI] 1.76 [1.11, 2.78]), pregnancy-induced …

Analysis Of Lead Levels In Deciduous Teeth From Children In Clark County, Nevada., Kristin Murphy, Jennifer Berger-Ritchie, Shawn L. Gerstenberger, Amol B. Amin, Jason K. Nitta, Frederick G. More, Jeanne A. Hibler, Karl Kingsley

Nevada Journal of Public Health

Background: Elevated blood lead levels (EBLL) are declining in the United States, although some population subgroups continue to exhibit significant health disparities. A childhood lead poisoning prevention program was recently started in Nevada, and many efforts have been made to support this program and increase the screening rates.

Methods: To expand the potential pool of children screened for EBLLs, a pilot study was performed to evaluate lead concentrations in extracted deciduous teeth using Graphic Furnace Atomic Absorption Spectrometry (GFAAS), Inductively Coupled Plasma Mass Spectrometry (ICP-MS), and X-Ray Fluorescence (XRF) analysis.

Results: Lead concentrations as determined by GFAAS and ICP-MS were …

African American And Non-Hispanic White Births In Enhanced Prenatal Care Programs And Wic, Monica Cain

Journal of Health Disparities Research and Practice

North Carolina uses Maternity Care Coordination (MCC), an enhanced prenatal care program, to improve birth outcomes for high risk women. The WIC program provides similar services to achieve the same goal. Women in North Carolina Medicaid can choose to participate in either, both, or neither the MCC and WIC programs. The study compares the percentages of low birth weight (LBW)—less than 2500 grams—births and maternal risk characteristics of women: (1) participating in the MCC program only, (2) participating in WIC only, or (3) participating in both programs, to those women who receive conventional Medicaid prenatal care. The analysis is further …

Evaluation Of A Tobacco Educational Intervention For Pregnant Alaska Native Women, Christi A. Patten, Carrie Enoch, Caroline C. Renner, Karin Larsen, Paul A. Decker, Kari J. Anderson, Caroline Nevak, Ann Glasheen, Kenneth P. Offord, Anne Lanier

Journal of Health Disparities Research and Practice

Tobacco cessation interventions developed and evaluated for Alaska Native women do not exist. As part of routine clinical care provided at a prenatal visit, a brief tobacco educational intervention for Alaska Native pregnant women (N=100; mean ± SD age = 25.9±6.2 years; mean 6.3± 2.6 months gestation) was piloted at the Y-K Delta Regional Hospital in Bethel, Alaska. This retrospective study reports on the evaluation of this clinical program. The intervention was consistent with the clinical practice guidelines (i.e., 5 A’s – ask, advise, assess, assist, arrange), with an average duration of 20.2 ± 6.8 minutes. The self-reported tobacco abstinence …

Examination Of Racial Disparities In Childhood Asthma Management Practices, Crystal N. Piper, Saundra Glover, Kieth Elder, Jong-Deuk Baek

Journal of Health Disparities Research and Practice

Objective: To analyze asthma management plan practices for children with asthma in the United States considering race and other demographic and person-level characteristics.

Methods: Univariate/Bivariate/Multivariate analysis was performed to examine asthma management plan physician recommendations among children in the United States utilizing secondary data analysis of the 2002 and 2003 National Health Interview Survey.

Results: The majority of the study participants reported not having an asthma management plan at (59.00%). In multivariate analysis using SAS callable SUDAAN, Whites were significantly more likely to have an asthma management plan (OR=1.66, p=.0031).

Conclusion: Findings from this study indicate that Black and Hispanic …

Utilizing Community Resources To Reduce The Presence Of Type 2 Diabetes In Rural Youth, Antonia S. Mead, M. C. Nagy, Stephen Nagy

Journal of Health Disparities Research and Practice

The purpose of this study was to implement a program designed to promote diabetes prevention activities among preadolescents in a rural southern setting using a day camp intervention. Participants in the study were eleven youth from a rural Alabama county who participated in a week-long half-day camp administered by local and community volunteers. Change scores were used to compare pre- to post- to follow-up measures for camp participant responses. Program results consistently demonstrated that the day camp was theoretically sound and that program activities positively impacted behavioral antecedents. This study demonstrated the feasibility of conducting a diabetes prevention day camp …

Race/Ethnicity As A Risk Factor Of Mother To Child Transmission Among Hiv Infected Mothers, Wei Yang, Fares Qeadan, Mona L. Brown, Michelle Chino, Scott Hall, Mary Guinan

Journal of Health Disparities Research and Practice

Objectives: African American women, living with HIV, exhibit a higher percentage of giving birth as compared to other race/ethnicity groups. The aim of this study is to understand the apparent black and non-black differences (health disparities) among the HIV Infected Mothers group and examine whether race/ethnicity can explain the high variation in different prenatal and HIV mother-to-child-transmission (MTCT) risk factors.

Methods: Data-Linkage was conducted on all women HIV+ cases, who delivered a child during the time period and reported to the Nevada state HIV with the live birth registries. Demographic and social data, separated into black and Non-black groups, were …

Family Home Visitors: Increasing Minority Women’S Access To Health Services, Mechthild Meyer, Alma R. Estable, Lynne Maclean, Wendy E. Peterson

Journal of Health Disparities Research and Practice

The article describes how service access barriers (language, trust) were addressed at different levels (organization, service provider, community) by involving Family Home Visitors to support Nurse Practitioners in providing pre- and postnatal services to linguis­tic minority women in Ontario. The investigators undertook a secondary analysis of 18 semi-structured interviews with health unit informants, Nurse Practitioners, program us­ers, and community leaders, including Family Home Visitors. Health units facilitated col­laboration between two programs aimed at serving mothers with young children, result­ing in both programs using Family Home Visitors. They enhanced minority women’s trust in Nurse Practitioner services by providing interpretation, outreach and …

Pap Test Follow-Up Pattern Among American Indian Women In Arizona, Merrill Eisenberg, Kathryn Coe, Charlton Wilson, Kathleen Evans, Elizabeth Brewer

Journal of Health Disparities Research and Practice

Objective: To quantify the loss to follow-up rate after abnormal Pap test results at the Phoenix Indian Medical Center, an Indian Health Service regional facility, and identify barriers to follow-up from the patients’ point of view.

Materials and Methods: Patient records were used to identify women who had abnormal Pap tests in 2002 and to document the status of their follow-up care. Women who had no clinical record of follow-up were contacted by telephone to arrange a follow-up appointment and to request participation in a structured qualitative interview to identify barriers to follow-up at the individual, family, community, and health …

The Impact Of Water Supply And Sanitation On Child Health: Evidence From Egypt, Rania Roushdy, Maia Sieverding, Hanan Radwan

Poverty, Gender, and Youth

Using a combination of qualitative and quantitative data, this working paper investigates whether access to improved sources of water and sanitation is an effective “treatment” for the incidence of diarrhea among children under five years of age in Egypt. Both components of the study indicate that widespread access to improved sources of drinking water and toilet facilities exists across Egypt; however, service quality remains a significant problem in many areas. In particular, cuts in water supply—and the resulting practice of storing water—are quite common; a sizable percentage of flush toilet facilities are not connected to the public sewer system; and …

Training Manual On The Use Of Magnesium Sulphate In The Management Of Severe Pre-Eclampsia And Eclampsia [Trainee Version], Federal Ministry Of Health, Population Council

Reproductive Health

This training manual provides detailed, descriptive, and practical instructions and tips necessary to respond to obstetric emergencies (severe pre-eclampsia and eclampsia). The manual is an integral part of the collaborative efforts between the Federal Ministry of Health and the MacArthur Foundation to scale up the use of magnesium sulphate in the management of severe pre-eclampsia and eclampsia in Nigerian health facilities. Magnesium sulphate has been established as the gold standard in the management of severe pre-eclampsia and eclampsia, but lack of knowledge and necessary skill have been identified as some of the factors responsible for its limited use in Nigeria. …

Family Planning Programs For The 21st Century: Rationale And Design, John Bongaarts, John C. Cleland, John Townsend, Jane T. Bertrand, Monica Das Gupta

Reproductive Health

Family planning improves health, reduces poverty, and empowers women. Yet, today, more than 200 million women in the developing world want to avoid pregnancy but are not using a modern method of contraception. They face many obstacles, including lack of access to information and health-care services, opposition from their husbands and communities, misperceptions about side effects, and cost. Family planning programs are among the most successful development interventions of the past 50 years. They are unique in their range of potential benefits, encompassing economic development, maternal and child health, educational advances, and women’s empowerment. Research shows that with high-quality voluntary …

Executive Summary—Family Planning Programs For The 21st Century: Rationale And Design, John Bongaarts, John C. Cleland, John Townsend, Jane T. Bertrand, Monica Das Gupta

Reproductive Health

This document contains the executive summary of “Family Planning Programs for the 21st Century: Rationale and Design.” The first half of the book makes the case for why increased funding and support for voluntary family planning programs are needed. The second half explains how reinvigorated voluntary family planning programs can be structured to operate more effectively. Family planning is one of the most successful development interventions of the past 50 years. It is unique in its range of potential benefits, encompassing economic development, maternal and child health, educational advances, and women’s empowerment. Research shows that with high-quality voluntary …

Policy Brief: Designing And Implementing High-Quality Voluntary Family Planning Programs, Population Council

Reproductive Health

Voluntary high-quality family planning programs reduce poverty and improve women’s and children’s health by speeding fertility declines. They are one of the most cost-effective health and development investments available to governments. But, today, more than 200 million women worldwide lack access to modern contraception. If this unmet need for family planning could be met, 54 million unintended pregnancies, 26 million abortions, more than 79,000 maternal deaths, and 1.1 million infant deaths could be prevented each year. This policy brief states that global interest in family planning is growing as the benefits of family planning programs are becoming increasingly evident. However, …

Policy Brief: Designing And Implementing High-Quality Voluntary Family Planning Programs [Arabic], Population Council

Reproductive Health

Voluntary high-quality family planning programs reduce poverty and improve women’s and children’s health by speeding fertility declines. They are one of the most cost-effective health and development investments available to governments. But, today, more than 200 million women worldwide lack access to modern contraception. If this unmet need for family planning could be met, 54 million unintended pregnancies, 26 million abortions, more than 79,000 maternal deaths, and 1.1 million infant deaths could be prevented each year. This policy brief states that global interest in family planning is growing as the benefits of family planning programs are becoming increasingly evident. However, …

Résumé Exécutif—Les Programmes De Planification Familiale Du Xxie Siècle: Fondement Et Conception, John Bongaarts, John C. Cleland, John Townsend, Jane T. Bertrand, Monica Das Gupta

Reproductive Health

Ce document contient le résumé exécutif de «Les programmes de planification familiale pour le XXIe siècle: Fondement et conception». La première moitié de l'ouvrage explique pourquoi un financement et un soutien accrus en faveur des programmes de planification familiale volontaire sont nécessaires. La seconde moitié explique comment les programmes renforcés de planification familiale volontaire peuvent être structurés de manière à fonctionner avec plus d’efficacité. La planification familiale est l'une des interventions les plus réussies de développement de ces 50 dernières années. Elle est unique en termes d’avantages potentiels, et englobe le développement économique, la santé maternelle et infantile, …

Prenatal Smoking And Drinking Implications For Subsequent Child Maltreatment, Nicholas Alexander Adams

Sociology & Criminal Justice Theses & Dissertations

Prenatal smoking and drinking are very serious problems that have continued to plague society. They have multiple negative effects on the child both physically and cognitively. This study explored the relationship between prenatal abuse, i.e., prenatal smoking and prenatal drinking, and subsequent child physical abuse and official reports of child maltreatment. It was hypothesized that mothers who smoked or drank prenatally would be more likely to physically abuse their child postnatally and have official reports of child maltreatment. The sample included women participating in Wave III of the National Longitudinal Survey of Adolescent Health. N = 620 women who answered …

Strengthening The Delivery Of Comprehensive Reproductive Health Services At The Community Level In Kenya, Population Council

Reproductive Health

The Population Council APHIA II Operations Research Project collaborated with the Ministry of Public Health and Sanitation to improve the quality of services offered by community-based midwives in two districts in Western Kenya, to prepare them to offer more comprehensive maternal services through antenatal, obstetric, postpartum, and newborn care. The study found that community midwives can tremendously increase clients’ access to essential maternal health services and other reproductive health services. Therefore Ministry of Health and its partners should scale up community midwives’ activities to enable more women access these services. Furthermore, information campaigns are needed to promote the range of …

First Generation Of Gender And Hiv Programs: Seeking Clarity And Synergy, Judith Bruce, Nicole Haberland, Amy Joyce, Eva Roca, Tobey Nelson Sapiano

Poverty, Gender, and Youth

In the past decade, there have been expanding resources to address the underlying gender dimensions of HIV. This has been particularly urgent in sub-Saharan Africa as the female-to-male infection ratios in young populations has reached 3 to 1 and sometimes above. The phrase “gender and HIV” has become commonplace yet does not provide any specific guidance as to target audiences, content, or measurable results. It can include everything from microcredit programs for HIV-positive women, to workplace programs seeking to change negative male norms, to efforts to increase respect for diverse sexual and gender identities. This review, conducted by the Population …

National Efforts Toward Fgm-Free Villages In Egypt: The Evidence Of Impact, Ghada Barsoum, Nadia Rifaat, Omaima El-Gibaly, Nihal Elwan, Natalie Forcier

Poverty, Gender, and Youth

This report is a midterm evaluation and documentation of the process and approach of the FGM-Free Village Model implemented in Egypt by the National Council of Childhood and Motherhood with assistance from the Population Council. In a comparison of responses from women and men in intervention groups to those in nonintervention (control) villages, data analysis shows that the program has been successful in changing views and attitudes toward female genital mutilation (FGM). FGM is an entrenched generational practice, and eradicating it in a community requires concerted effort over an extended period of time. This evaluation strongly recommends that efforts be …

Making Hiv Services More Responsive To Young Children And Infants In Nyanza, Monica Wanjiru

Reproductive Health

Health workers in Kenya often miss opportunities to discuss pediatric HIV with clients and to track exposed children in order to initiate treatment. To address this problem, the Population Council’s APHIA II Operations Research Project collaborated with the Christian Health Association of Kenya, Catholic Relief Services, and the Kendu Adventist Hospital to improve HIV testing and treatment services for children at the hospital. The project recommended that pediatric HIV services be strengthened and included as an essential service at all levels of healthcare facilities in order to reach more children, including as one of the roles of the community health …

Service Improvements And Community Education Lead To Increase In Uptake Of Hiv Services For Infants And Young Children, Population Council

Reproductive Health

The Population Council’s APHIA II Operations Research Project in Kenya collaborated with Kendu Adventist Hospital and the Christian Health Association to launch a study to examine the effect of improved services and awareness-creation on the uptake of HIV testing and treatment services for children and infants exposed to HIV. The study showed that community education and improvements in individual case tracking can increase the proportion of infants exposed to HIV who are tested for HIV and put on appropriate treatment. The policy brief recommends that health facilities streamline services to ensure that as many exposed infants as possible are identified …

The Relationship Between Breastfeeding And Child Care For Working Mothers In The United States, Patricia Wonch Hill

Department of Sociology: Dissertations, Theses, and Student Research

Whether or not child care provider characteristics and factors related to the care giving environment impact breastfeeding duration for working mothers has not been systematically studied. In this dissertation, I use Ecological Health Promotion Theory to explore the relationship between child care and breastfeeding through three different analyses. First, I interviewed nine child care providers to assess their knowledge, attitudes and beliefs about infant feeding and whether they vary on these factors across individuals and child care licensing types. Second, I conducted a small mail survey of 93 licensed child care providers in order to create a scale measuring attitudes …

Forced Migration And The Survival Needs Of The Nigerian Child, Ngozi Diwunma Obidike

Journal of Global Initiatives: Policy, Pedagogy, Perspective

This article identifies the survival needs of the forced migrant Nigerian child as well as the extent to which the identified needs are satisfied. The population consisted of 600 forced migrant children and 10 emergency workers who were chosen based on their experiences being forced migrants. A questionnaire was used for the study. The result showed) among other things, that although the need for food, clean water, education, peace, and shelter were identified as the five most essential needs, other needs were also identified as necessary for the children's survival. Based on the results, recommendations were made.