Medicine and Health Commons^™

The Implications Of Early Marriage For Hiv/Aids Policy, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

This brief is based on a background paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents, held in Geneva, Switzerland, December 9–12, 2003. The final paper is entitled “Including married adolescents in adolescent reproductive health and HIV/AIDS policy.” The consultation brought together experts from the United Nations, donors, and nongovernmental agencies to consider the evidence regarding married adolescent girls’ reproductive health, vulnerability to HIV infection, social and economic disadvantage, and rights. The relationships to major policy initiatives—including safe motherhood, HIV, adolescent sexual and reproductive health, and reproductive rights—were explored, and emerging findings from the still relatively rare programs …

Including Married Adolescents In Adolescent Reproductive Health And Hiv/Aids Policy, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

The majority of sexually active girls aged 15–19 in developing countries are married, and married adolescent girls tend to have higher rates of HIV infection than their sexually active, unmarried peers. Married adolescent girls represent a sizable fraction of adolescents at risk and experience some of the highest rates of HIV prevalence of any group. Nonetheless, married adolescents have been marginal in adolescent HIV/AIDS policies and programs and have not been the central subjects for programs aimed at adult married women. This paper offers a partial explanation for why married adolescents have so often been overlooked, the reasons why marriage …

Les Implications Du Mariage Précoce Pour Les Politiques De Vih/Sida, Judith Bruce, Shelley Clark

Poverty, Gender, and Youth

Ce dossier est basé sur un document contextuel préparé pour la Consultation Technique OMS/ FNUAP/Population Council sur les Adolescentes Mariées, tenue à Genève en Suisse du 09 au 12 Décembre 2003 (le document final intitulé "Inclure les adolescentes mariées dans les politiques de santé reproductive des adolescents et de VIH/SIDA"). La Consultation a réuni des experts provenant des Nations Unies, des bailleurs de fonds et des agences non gouvernementales pour examiner les faits concernant la santé reproductive des adolescentes mariées, leur vulnérabilité face à l’infection du VIH, leurs inégalités sociales et économiques ainsi que leurs droits. Les rapports avec des …

Testing The Effectiveness Of Integrating Community-Based Approaches For Encouraging Abandonment Of Female Genital Cutting Into Care's Reproductive Health Programs In Ethiopia And Kenya, Jane Chege, Ian Askew, Susan Igras, Jacinta Muteshi-Strachan

Reproductive Health

CARE International, with technical support from the Frontiers in Reproductive Health Program completed a study in Ethiopia and Kenya designed to test the effectiveness of education activities using behavior change communication (BCC) approaches and advocacy activities by religious and other key leaders to abandon female genital cutting (FGC). In Ethiopia, the increased knowledge of harmful FGC effects and human rights issues translated to a positive attitude in support of FGC abandonment and an intention not to cut their daughters in the future. In Kenya, the analysis indicated mixed results in attitude and intended behavior change.

Next-Of-Kin Perceptions Of Physician Responsiveness To Symptoms Of Hospitalized Patients Near Death, Joel C. Cantor, Jan Blustein, Matthew J. Carlson, David A. Gould

Sociology Faculty Publications and Presentations

Many different medical providers visit critically ill patients during a hospitalization, and patients and family members may not feel any physician is truly in charge of care. This study explores whether perceiving that a physician was clearly in charge is associated with reports by surviving next of kin about the responsiveness of physicians to symptoms in hospitalized patients near the end of life. We conducted telephone interviews with surviving next of kin of adult patients (n = 1107) who died in one of five New York City teaching hospitals between April 1998 and June 1999 after a minimum 3-day inpatient …

Introduction Of A Waterless Alcohol-Based Hand Rub In A Long-Term Care Facility, Lona Mody, Mcneil A. Shelly, Rongjun Sun, Bradley Suzanne, Carol A. Kauffman

Sociology & Criminology Faculty Publications

OBJECTIVE:

To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF).

METHODS:

Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub.

RESULTS:

Hand hygiene practices, knowledge, and opinions did not change after …

Expanding Self-Direction In Services For The Aged And People With Disabilities, Ruth A. Burgess

Theses, Dissertations and Capstones

Medicaid-funded long-term care services are traditionally delivered in nursing homes. States may apply for waivers which allow them to provide home and community based services with Medicaid funds. Because these services are by definition an alternative to nursing home care, waiver services are generally based upon a medical model which emphasizes medical deficits and tends to restrict consumers’ movements to inside the home. Recent developments such as the Olmstead Decision and federal New Freedom Initiatives have caused states to recognize that consumers desire and have a legal right to be part of a community rather than institutionalized or homebound. These …

Reproductive Health Services In Kwazulu Natal, South Africa: A Situation Analysis Study Focusing On Hiv/Aids Services, Lewis Ndhlovu, Catherine Searle, Robert A. Miller, Andrew A. Fisher, Ester Snyman, Nancy L. Sloan

HIV and AIDS

This Horizons report examines the readiness of reproductive health services in South Africa, which are primarily geared to women, to deliver HIV and AIDS treatment, care, and prevention services. The goal of the study was to obtain information from a representative sample of provincial health care facilities offering reproductive health services in KwaZulu Natal to meet the growing demand for HIV/AIDS-related services. Ninety-eight hospitals, community health centers, and clinics participated in the situation analysis that identified gaps in service delivery and determined priorities for service integration. Results of the study were presented to a large audience of Department of Health, …

Empowering Communities To Respond To Hiv/Aids: Ndola Demonstration Project On Maternal And Child Health: Operations Research Final Report, Hope Humana, Linkages, National Food And Nutrition Commission, Ndola District Health Management Team, Horizons Program, Zambia Integrated Health Project

HIV and AIDS

A pre–post intervention study conducted in Zambia by Horizons and local NGOs and governmental organizations demonstrated that HIV voluntary counseling and testing (VCT) and infant feeding counseling (IFC) to mothers attending maternal and child health (MCH) clinics are vital components of any mother-to-child transmission (MTCT) reduction strategy, whether or not antiretrovirals (ARVs) are available. These interventions enable mothers to make informed and healthy decisions. Data from the Ndola Demonstration Project yielded encouraging results from efforts to improve the capacity of mothers to make informed decisions about their own health and the health of their infant. The interventions succeeded in raising …

Microfinance And Households Coping With Hiv/Aids In Zimbabwe: An Exploratory Study, Carolyn Barnes, Erica Keogh, Nontokozo Nemarundwe, Loveness Nyikahadzoi, Ellen Weiss

HIV and AIDS

This study, conducted in Zimbabwe, sought to better understand the relationship between a microfinance program, Zambuko Trust, and how microentrepreneurs’ households cope with the impact of HIV/AIDS. The study examined how HIV/AIDS is affecting Zambuko’s operations and what microfinance institutions (MFIs) can do to lessen the impact of HIV/AIDS on their clients and operations. The findings indicate several small yet important ways that MFI programs help microentrepreneurs and their families respond to these impacts through access to credit and business management training. Participation in a microfinance program led to income smoothing and better financial management, which can help households mitigate …

Evaluating Operations Research Utilization: Guidelines For Assessing Process And Impact, M. Celeste Marin, Jane T. Bertrand

Reproductive Health

The Population Council has been providing technical assistance and conducting Operations Research (OR) studies in family planning and reproductive health for over two decades. These studies are designed to identify problems and test strategies to resolve those problems, providing program managers, administrators, and policymakers with the information they need to improve service-delivery systems. The ultimate goal is that strategies tested through OR will be adopted, leading to changes in policy or operational procedures at institutional, national, or international levels. These changes are what we refer to as impact. The purpose of the new approach to evaluation described in this Evaluation …

Meeting The Sexual Health Needs Of Men Who Have Sex With Men In Senegal, Cheikh Ibrahima Niang, Moustapha Diagne, Youssoupha Niang, Amadou Moreau, Dominique Gomis, Maye Diouf, Karim Seck, Abdoulaye Sidibe Wade, Placide Tapsoba, Christopher Castle

HIV and AIDS

A study conducted in Dakar, Senegal by researchers from the National AIDS Council, Cheikh Anta Diop University, and the Horizons program obtained information on the needs, behaviors, knowledge, and attitudes of men who have sex with men (MSM). This study offers important insights into the sexuality of MSM, their vulnerability to STI/HIV, and the role of violence and stigma in their lives. The results also highlight the lack of sexual health services and information available to cover the specific needs of MSM. The results of this study were summarized during a meeting held in April 2001 in Dakar and raised …

Hiv/Aids Prevention Guidance For Reproductive Health Professionals In Developing-Country Settings, Helen Epstein, Daniel Whelan, Janneke Van De Wijgert, Purnima Mane, Suman Mehta

HIV and AIDS

While the integration of information, technologies, and services to respond to HIV/AIDS may seem closely related, there are a variety of issues that continue to create obstacles to integration. Among these are the stigmatizing nature of HIV infection and AIDS and discrimination faced by those who are infected or perceived to be infected; sexual practices and identities that remain socially unacceptable; gender roles and relations that make it difficult for women and men to access information, services, and technologies on HIV prevention; reluctance to recognize the special needs of young people; and barriers to service delivery created by broader economic, …

An Analysis Of The Changing Forces Behind Health Insurance Coverage Of Homebirth, Christina Anne Gasbarro

Dissertations and Theses

The expansion of managed care, which is premised on containing costs while maintaining market share, represents a radical transformation of the U.S. health care system. A central question for medical sociologists is to determine how the changes brought by managed care influence health insurance and health care options. In evaluating the impacts of managed care, obstetrics is a particularly important site of study. Part of this agenda involves gathering baseline data on a specific transformation in obstetrics practice new to the managed care scene: the emergence of health insurance coverage for the option of home birth. The research project detailed …

Transitions To Adulthood In The Context Of Aids In South Africa: Report Of Wave I, Naomi Rutenberg, Cathrien Kehus-Alons, Lisanne Brown, Kate Macintyre, Anthea Dallimore, Carol E. Kaufman

HIV and AIDS

This is a prospective study of reproductive behavior and sexual health of adolescents in South Africa as well as their education and employment experiences, family and environmental conditions, and other factors in their lives that may influence their sexual behavior and choices. This report is designed to inform educators, policymakers, and the public in South Africa and beyond of the initial findings of the study, with the ultimate goal of helping to design and refine policies and programs that will improve opportunities and capacities of adolescents and may contribute to changing behaviors and choices. The report focuses on describing the …

Prevention Of Trafficking And The Care And Support Of Trafficked Persons In The Context Of An Emerging Hiv/Aids Epidemic In Nepal, Celine Daly

HIV and AIDS

This study is a collaborative effort between the Asia Foundation (Kathmandu) and the Horizons project of the Population Council (New Delhi) to document the current intervention models and community-based study of human trafficking in the context of an emerging HIV/AIDS epidemic in Nepal. To address the human rights component of trafficking, the three components of this study focus on the rights and needs of trafficked persons as well as those who are vulnerable to trafficking. An analysis and assessment of the effectiveness of laws, policies, and interventions in the apprehension, prosecution, and conviction of alleged traffickers is not included in …

Hiv And Partner Violence: Implications For Hiv Voluntary Counseling And Testing Programs In Dar Es Salaam, Tanzania, Suzanne Maman, Jessie K. Mbwambo, Margaret Hogan, Gad P. Kilonzo, Michael D. Sweat, Ellen Weiss

HIV and AIDS

This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Men and women both perceive HIV testing as a way to plan for the future but are motivated to undergo testing by a number of different individual, relationship, and environmental factors. The women in our study described more barriers to HIV testing than did men, and women who have communicated with their partners about VCT before seeking services are significantly more likely to share their HIV test results than those who have not talked with their …

The Case For Microbicides: A Global Priority, Kathy Attawell

HIV and AIDS

The HIV/AIDS epidemic continues to spread, undermining development, reversing health gains, and exacerbating poverty. It will be some time before a vaccine is available and accessible, thus there is an urgent need to identify additional prevention options, in particular a method that women control, which could save millions of lives. This report from the Population Council and International Family Health presents the case for microbicides—products used vaginally to prevent infection from HIV and other STIs in women and their sexual partners—and discusses recent progress and developments, outstanding challenges, and the action required to ensure that products will be made available …

Benin: Diríjase A Los Hombres Para Aumentar El Uso De Los Servicios De Salud, Frontiers In Reproductive Health

Reproductive Health

Después del inicio de las reformas del sector salud en 1994, el gobierno de Benin creó el Proyecto de Salud Familiar Integral, conocido localmente como PROSAF. Este proyecto opera en la región de Borgou, bajo el patrocinio de la Agencia de los Estados Unidos para el Desarrollo Internacional. Dicha región es en su mayoría rural y en ella se observan los problemas de salud más severos del país. Los gerentes de PROSAF deseaban entender por qué la gente no estaba utilizando los servicios a pesar de tener una salud deficiente, por lo que solicitaron al Centro Africano de Investigación en …

Improving Quality Of Care In India's Family Welfare Programme: The Challenge Ahead, Michael A. Koenig, M.E. Khan

Reproductive Health

This book on family planning in India includes detailed empirical data and analysis of the various dimensions of quality of care in different regions of the country. Focus areas include: women’s perceptions of the care they receive; observations of provider-client interactions; barriers to quality of service delivery; existing interregional variations; contraceptive choice and interpersonal relations; technical quality of care; and the effect of the target system on the work style of outreach staff. All elements of the quality-of-care framework elaborated by Judith Bruce are well documented and their relationships to broader program constraints are clearly identified. The overall impression one …

Investigación Operativa En Planificación Familiar: Lecturas Selectas, James R. Foreit, Tomas Frejka

Reproductive Health

Desde que existen los programas de planificación familiar existe la investigación sobre este tema. En el nivel teórico, los investigadores examinan el efecto de la fertilidad sobre la salud y el desarrollo socioeconómico y estudian los determinantes de la fecundidad para los individuos y la poblaciones. En el nivel de las políticas, los estudios exploran el papel que juegan los programas de planificación familiar en la modificación de la fecundidad y la salud. El desarrollo de nuevos anticonceptivos se acompaña de pruebas clínicas y pre-introductorias en el contexto de los programas. Se llevan a cabo encuestas para medir los cambios …

L'Approche De L'Analyse Situationnelle Pour L'Évaluation Des Services De Planification Familiale Et De Santé De La Reproduction: Manuel De Recherche, Robert A. Miller, Andrew A. Fisher, Kate Miller, Lewis Ndhlovu, Baker Ndugga Maggwa, Ian Askew, Diouratie Sanogo, Placide Tapsoba

Reproductive Health

Une bonne prestation de services de planification familiale mettant l'accent à la fois sur l'accès et la qualité est la clé des objectifs interdépendants de satisfaction des besoins individuels et la réalisation du succès programmatique. L'analyse de situation (AS) fournit un lien nécessaire entre le responsable de programme et la cliente qu'il essaie de servir. Les données recueillies par l’AS offrent une image représentative du fonctionnement des composantes et permettent de «voir» l'expérience de la cliente. Les analyses situationnelles aident le responsable de programme à atteindre le plus grand but en termes de gestion—celui d’une administration efficace d'un service de …

Manuel De Recherche Opérationnelle En Matière De Planification Familiale, Andrew A. Fisher, John E. Laing, John E. Stoeckel, John Townsend

Reproductive Health

Le Manuel de recherche opérationnelle en matière de planification familiale, publié pour la première fois en anglais par le Population Council en 1984, se basait sur des projets de recherche en Asie. Cette seconde édition contient des sections révisées et développées. Le cas échéant, des exemples d'Amérique latine et d'Afrique ont été ajoutés. Le chapitre d'introduction comprend une exposé actualisé sur le processus de la recherche opérationnelle (RO) en matière de santé et planification familiale. De nouveaux chapitres concernent le choix du type d’intervention à tester dans une étude RO ainsi que les principaux éléments constituant un programme d'intervention. Le …

La Familia En La Mira: Nuevas Perspectivas Sobre Madres, Padres E Hijos, Judith Bruce, Cynthia B. Lloyd, Ann Leonard, Patrice L. Engle, Niev Duffy

Poverty, Gender, and Youth

A pesar de la retórica de los últimos años que lamenta la pérdida de la "familia tradicional," las familias jamás se han podido encajonar en modelo único. "Familia" puede referirse a la gente que se ha vinculado entre sí por matrimonio o parentesco, o a los que pretenden descender de antecesores comunes. Las personas pueden formar y extender familias, ya sea mediante la adoptación o crianza de niños, o definiendo como familiares a gente no emparentada o mediante el establecimiento de sociedades consensuales. Las familias son tan adaptables como diversas, pues se reconfiguran a sí mismas en el transcurso de …

The Uncharted Passage: Girls' Adolescence In The Developing World, Barbara Mensch, Judith Bruce, Margaret E. Greene

Poverty, Gender, and Youth

Adolescence is a formative time of transition to adulthood. What happens between the ages of 10 and 19 shapes how girls and boys live out their lives as women and men—not only in the reproductive arena, but in the social and economic realm as well. Yet, despite its impact on human development, adolescence has been sidelined as a research and policy subject in developing countries. While all adolescents deserve our attention, the needs of adolescent girls in the developing world are particularly pressing. This monograph focuses on these girls, presenting statistics to examine the social and economic context of their …

Family Planning Operations Research: A Book Of Readings, James R. Foreit, Tomas Frejka

Reproductive Health

For as long as there have been family planning programs, there has been family planning research. At the theoretical level, researchers examine the effect of fertility on health and socioeconomic development and study the determinants of fertility for individuals and populations. At the policy level, studies explore the role of family planning programs in modifying fertility and health. The development of new contraceptives is accompanied by clinical and pre-introductory trials in program settings. Surveys measure changes in contraceptive use and fertility, and the results are used to make decisions affecting programs. Finally, programs themselves carry out operations research (OR) to …

Do Population Policies Matter? Fertility And Politics In Egypt, India, Kenya, And Mexico, Anrudh K. Jain

Reproductive Health

How are effective population policies articulated and implemented? Have international agencies played a strong role in prompting developing-country governments to adopt and implement strong population policies? How has the international debate influenced deliberations on population issues in developing countries? The impetus for the four country studies presented in this book was provided by a desire to better understand some of these issues within specific contexts. Egypt, India, Kenya, and Mexico were selected because of their demographic weight, a long history of population policies and programs, and evidence of fertility decline. The four country studies examine the influence of many forces …

The Relationship Between The Intensity And Duration Of Extracurricular Activities And Teenage Pregnancy, Rhonda L. Drilling

Dissertations and Theses @ UNI

Extensive research has been done in the area of adolescent pregnancy prevention. One possible means of prevention that has not been adequately explored is involvement in extracurricular school activities. The purpose of this study was to determine if a relationship existed between the intensity and duration of participation in extracurricular school activities and the incidence of teenage pregnancy. In the study, 200 female high school students who had never been pregnant and 36 females who had become pregnant as teenagers were surveyed. All females were from Fayette County, Iowa. A 33-item questionnaire was used to survey the two groups regarding …

The Situation Analysis Approach To Assessing Family Planning And Reproductive Health Services: A Handbook, Robert A. Miller, Andrew A. Fisher, Kate Miller, Lewis Ndhlovu, Baker Ndugga Maggwa, Ian Askew, Diouratie Sanogo, Placide Tapsoba

Reproductive Health

Good family planning service delivery emphasizing both access and quality is key to the related goals of satisfying individual needs and achieving programmatic success. Situation Analysis (SA) provides a needed link between the manager and the client he or she is trying to serve. The data marshaled for SA offer a representative picture of how subsystems are working and provide a way to “see” the client’s experience. Situation Analyses assist managers in achieving the broadest management goal—that of efficient administration of a vital health care service while keeping in view the ultimate goal—providing good care for those who seek it. …

Coalition Building: Moving Toward Effective Coalitional Strategies Of Hiv/Aids Prevention In Communities Of Color, Lisa Roland

Trotter Review

Despite the overwhelming burden carried by blacks and Latinos in terms of AIDS, it has become evident that in keeping with the general and historical pattern of discrimination reflected in funding, allocation of resources, policies etc., communities of color have received insufficient support to effectively address the problem at hand. Further compounding this dilemma, communities of color have fought against each other to secure funding for particular community programs. While looking at our individual, immediate, and entirely valid needs, many of us have at times failed to see the impact of our individual actions and attitudes on a broader picture.