International Public Health Commons^™

Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Peshawar, Population Council

Reproductive Health

This district profile of Peshawar is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of use of antenatal and delivery care services; other socioeconomic indicators; availability of health facilities, pharmacies, and lady health workers; distribution of public static and private facilities by cadre; provision of specific family planning methods by sector; and presence and provision of family planning services/products. The factsheet concludes with a review of consumers’ perspectives on barriers to use of family planning and a chart listing district-specific donors, projects, and implementing partners. The analysis, conducted by the …

Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Rawalpindi, Population Council

Reproductive Health

This district profile of Rawalpindi is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of use of family planning and other socioeconomic indicators. It covers consumers’ perspectives on barriers to use of family planning noting the lack of information among men and women, especially migrants; problems of access among poor rural women; and difficulty in affording services, among poor couples. The factsheet concludes with a chart listing district-specific donors, projects, and implementing partners. The analysis, conducted by the Population Council, was supported by the Bill & Melinda Gates Foundation.

Understanding Married Women's Vulnerability To Hiv Infection In Egypt: An Exploratory Study, Doaa Oraby, Nahla G. Abdel-Tawab

Reproductive Health

This study examines the behavioral, sociocultural, economic, programmatic, and legal factors that aggravate Egyptian women’s vulnerabilities to HIV/AIDS. The study concludes that in low-prevalence settings like Egypt, targeted interventions are the most strategic and cost-effective: for example, HIV awareness-raising with a special focus on the preventive role of consistent, correct condom use, and creating a cadre of peers that could provide psychosocial support and HIV counseling to migrant workers. Furthermore, premarital and antenatal care programs should include HIV awareness-raising and provider-initiated counseling and testing after screening of women to identify those at risk for HIV infection. Concurrently, efforts should be …

Using The Community Informant Based (Made-In And Made-For) Methodology For Estimating Maternal Mortality Ratio (Mmr) In Districts Haripur And Nowshera, Khyber Pakhtunkhwa, Population Council

Reproductive Health

Through its Reproductive Maternal and Neonatal Child Health project, GIZ Pakistan is assisting the Government of Pakistan in strengthening its health system’s capacities for ensuring effective, efficient, client-oriented, and affordable reproductive, maternal, newborn, and adolescent health care. GIZ engaged with senior national and provincial government officials who indicated their interest in applying the innovative Made-In/Made-For (Maternal Death, from Informants/Maternal Death, Follow On Review) methodology, a cost-effective alternative for generating reliable estimates of maternal mortality through community-based informant networks. This Population Council study in two pilot districts identified specific areas that need strong policy and programmatic interventions to improve maternal health …

Using The Community Informant-Based (Made-In And Made-For) Methodology To Estimate The Neonatal Mortality Rate (Nmr) In Nowshera, Khyber Pakhtunkhwa: A Feasibility Study, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood, Mansoor Qaisar, Sabahat Hussain, Rehan M. Niazi

Reproductive Health

Concerned about high levels of neonatal mortality, the Khyber Pakhtunkhwa district government in Pakistan expressed a need to adapt and test a new approach—commonly referred to as the “Made-In/Made-For” (MIMF) method—that uses community-based informants to estimate the number of maternal deaths. The current pilot study in Nowshera was commissioned by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH and conducted by the Population Council to test the feasibility of using the method, and community-based informant networks that had been used to measure maternal mortality, for estimating neonatal deaths. This study clearly shows that, in addition to identifying maternal deaths, informant …

Using The Community Informant Based (Made-In And Made-For) Methodology For Estimating Maternal Mortality Ratio (Mmr) In Khyber Pakhtunkhwa, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood

Reproductive Health

This report documents a study by the Population Council estimating the maternal mortality ratio of Khyber Pakhtunkhwa (KP) province in Pakistan using an innovative community informant–based method, known as the “Made-In/Made-For” (MIMF) technique, to collect data on maternal deaths. The report confirms that maternal mortality persists as a major public health issue in KP, and the problem may be much larger than assumed. The study’s success in identifying causes of death through verbal autopsies and their subsequent disaggregation into direct and indirect causes is important from policy and programmatic perspectives. Interventions need to focus both on direct and indirect causes …

Hiv Risk And Psychological Distress Among Female Entertainment Workers In Cambodia: A Cross-Sectional Study, Carinne M. Brody, Pheak Chhoun, Sovannary Tuot, Khuondyla Pal, Siyan Yi

Background: In Cambodia, there has been an increase in entertainment work as a result of the breakdown of the traditional brothel-based sex industry, presenting new challenges to addressing the health issues and needs of people working in the entertainment industry. This study aims to identify factors associated with psychological distress among female entertainment workers (FEWs) in Cambodia.

Methods: A two-stage cluster sampling method was used to randomly select 657 FEWs from entertainment establishments in Phnom Penh and Siem Reap in April and May 2014 for interviews using a structured questionnaire. Psychological distress was measured using the General Health …

Are Text Messages A Feasible And Acceptable Way To Reach Female Entertainment Workers In Cambodia With Health Messages? A Cross-Sectional Phone Survey, Carinne M. Brody, Sukhmani Dhaliwal, Sovannary Tuot, Michael Johnson, Khuondyla Pal, Siyan Yi

Background: Despite great achievements in reducing the prevalence of HIV, eliminating new HIV infections remains a challenge in Cambodia. Entertainment venues such as restaurants, karaoke bars, beer gardens, cafes, pubs, and massage parlors are now considered important venues for HIV prevention efforts and other health outreach interventions.

Objective: The purpose of this study was to explore phone use and texting practices of female entertainment workers (FEWs) in order to determine if text messaging is a feasible and acceptable way to link FEWs to health services.

Methods: This cross-sectional phone survey was conducted in May 2015 with 97 …

Determinants Of Inconsistent Condom Use Among Hiv Serodiscordant Couples In Cambodia, Sovannary Tuot, Khuondyla Pal, Kouland Thin, Chrysanta Patio, Kelly Allbritton, Christie Blondek, Siyan Yi

Background: Globally, heterosexual transmission within serodiscordant relationships is a significant source of new HIV infections. In 2012, there were an estimated 1,350 incident cases of HIV in Cambodia, of which 37% were between heterosexual couples and 30% among sex workers. In combination with antiretroviral therapy (ART), consistent condom use can significantly reduce HIV transmission risk among serodiscordant couples. This study explored determinants of inconsistent condom use among serodiscordant couples in Cambodia. Methods: A cross-sectional study was conducted in Battambang, Pursat and Takeo provinces in September 2013. A structured questionnaire was used to collect data on condom use and …

Health And Socio-Economic Impacts Of Livelihoods Programs Among People Living With Hiv In Cambodia: A Case-Control Study, Sovannary Tuot, Kouland Thin, Mayumi Shimizu, Samedy Suong, Samithrea Sron, Pheak Chhoun, Siyan Yi

Background: In Cambodia, the circumstances surrounding people living with HIV (PLHIV) remain serious conditions. To ameliorate these situations, KHANA has implemented livelihoods programs since 2010, including village saving and loans (VSL), skill trainings, and cash grants with on-going technical support. This study aims to evaluate the impacts of the programs in improving socio-economic conditions, health, and psychological well-being of PLHIV in Cambodia. Methods: In August 2014, a case-control study was conducted in six selected provinces. The cases were defined as PLHIV who lived in the selected operational districts where KHANA has implemented the livelihoods programs, and have participated in …

Social Return On Investment: A Cost-Benefit Analysis Of The Hiv Integrated Care And Prevention Programs In Cambodia, Sovannary Tuot, Liza Tong, Sopheab Heng, Minh-Anh Luong, Khuondyla Pal, Pheak Chhoun, Siyan Yi

Background: KHANA’s HIV Integrated Care and Prevention (ICP) project provided comprehensive care and support to HIV-affected communities through home and community-based care teams from 2007 to 2011. The aim of this study was to use Social Return on Investment (SROI) methodology to evaluate the social, health, and economic impacts of the ICP project, enabling the calculation of a ratio cost-to-benefit for the community in terms of HIV care, support, and treatment. Methods: The SROI methodology is a social cost-benefit analysis framework that measures and accounts for the values created by a program or series of initiatives. Values were mapped to …

Improving Prevention And Care For Hiv And Sexually Transmitted Infections Among Men Who Have Sex With Men In Cambodia: The Sustainable Action Against Hiv And Aids In Communities (Sahacom), Siyan Yi, Sovannary Tuot, Pheak Chhoun, Khuondyla Pal, Chanrith Ngin, Sok Chamreun Choub, Carinne M. Brody

Background: The prevalence of HIV and sexually transmitted infections (STIs) among key populations in Cambodia continues to rise. To address this issue, KHANA, the largest national HIV organization in the country developed and implemented the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project. This study aims to determine the impacts of the SAHACOM on sexual behaviors and the uptake of HIV/STI services among men who have sex with men (MSM) in Cambodia.

Methods: We compared outcome indicators at midterm (n = 352) and endline (n = 394). Surveys were conducted in 2012 and 2014 in Battambang …

Acceptability Study On Hiv Self-Testing Among Transgender Women, Men Who Have Sex With Men, And Female Entertainment Workers In Cambodia: A Qualitative Analysis, Khuondyla Pal, Chanrith Ngin, Sovannary Tuot, Pheak Chhoun, Cheaty Ly, Srean Chhim, Siyan Yi

Background: In Cambodia, HIV prevalence is high while HIV testing rates remain low among transgender women (TG women), men who have sex with men (MSM), and female entertainment workers (FEW). Introducing self-testing for HIV to these key populations (KPs) could potentially overcome the under-diagnosis of HIV and significantly increase testing rates and receipt of the results, and thus could decrease transmission. Therefore, this study aimed to determine the acceptability of HIV self-testing (HIVST) among these three categories of KPs.

Methods: This study was conducted through focus group discussions (FGDs) with TG women, MSM, and FEW in Phnom Penh …

Men Who Have Sex With Men In Cambodia: Population Size, Hiv Risky Behaviors, And Hiv Prevalence, Siyan Yi, Srean Chhim, Pheak Chhoun, Sovannary Tuot, Cheaty Ly, Phalkun Mun, Chanrith Ngin

Background: Men who have sex with men (MSM) constitute a significant proportion of HIV key populations in Cambodia. We conducted this study to estimate the national population size, assess HIV-related risk behaviors, and determine HIV prevalence among MSM in Cambodia. Methods: This research was conducted in 2014 in 12 study sites in Cambodia. MSM size estimation was performed using capture-recapture method with data collected in two time points within an 18-day interval. To assess HIV risk behaviors, a total of 838 MSM were randomly selected for face-to-face interviews during the capture round. A separate survey using a time …

Research Ethics Training Of Trainers: Developing Capacity Of Bolivian Health Science And Civil Society Leaders, Annette Aalborg, Sarah Sullivan, Jacqueline Cortes, Armando Basagoitia, Daniel Illanes, Matthew Green

Research and research ethics (RE) capacity is a key element for addressing health priorities of low- and middle-income countries (LMICs). With support from a NIH/FIC Research Ethics Education and Curriculum Development grant, a RE Training of Trainers (TOT) was implemented in Bolivia. The Steering Committee, including representatives from four Bolivian universities and PAHO, developed the RE TOT that included face-to-face, online and practicum components. Twenty trainees including faculty, researchers and community leaders participated. Pre/Posttest results demonstrated significant increases in overall RE knowledge (13.1% improvement, p-value < 0.0001). An evaluation demonstrated participants valued participatory learning strategies and the flexibility of the online component. TOT participants during the practicum component delivered RE workshops to their university and civil society communities in four regions (n= 3,700 people). The goals of the grant were accomplished through the development of a Steering Committee and implementation of the TOT course. Next steps include the design and implementation of a master’s level research ethics education program in Bolivia.

Documento Faz Diferença, Carlos Eduardo Siqueira, Gabriella Barretosoares, Pedro L Araújo Neto, Maria N Tracy

Gastón Institute Publications

Brazilian immigrants in the United States experience various social, labor, and health challenges. This study aimed to analyze the profile of female Brazilian domestic workers in Massachusetts, USA, through a description of their working conditions and sel-frated health. This was a cross-sectional study of 198 domestic workers in Massachusetts, recruited with “snowball” sampling. The instrument addressed participants’ demographic characteristics, work conditions, and self-rated health. Data were analyzed with SPSS 21.0. Among the interviewees, 95.5% were women, 62.1% were 30 to 49 years of age, and 55.6% were undocumented. Documented and undocumented participants showed statistically significant differences in demographics, work conditions, …

Neoliberalism Redux: The Global Health Policy Agenda And The Politics Of Cooptation In Latin America And Beyond, Anne E Birn, Laura Nervi, Carlos Eduardo Siqueira

Gastón Institute Publications

This article explores the neoliberal cooptation of social justice-oriented global health policies over the last three decades, from primary health care and ‘health for all’ to various contemporary so-called ‘health equity’ initiatives, such as Universal Health Coverage and ‘health convergence’. The authors illustrate and contextualize the different periods and approaches with examples from a range of Latin American countries, drawing on diverse political experiences and social struggles in the health arena. The analysis concludes with reflections about the region’s experiences of resisting and challenging the neoliberal health agenda, in spite of domestic and global environments that have constrained these efforts, …

A Cross-Sectional Study On Patients' Access To Healthcare In A Developing Nation, Pawan Bhandari

All Graduate Theses, Dissertations, and Other Capstone Projects

The objective of this research study was to gauge the current status of patients' access to health care services in a developing nation or least-developed country (as defined by the World Bank and United Nations), Nepal. Many patients are not privileged to have a hospital at a close proximity in Nepal. They are also forced to travel and wait for long hours due to their inability to pay for services offered by private healthcare institutions. A survey questionnaire was developed to get a snapshot of how long patients travel to get to a public hospital for an outpatient service. The …

Socioeconomic Factors Associated With Cataract-Related Blindness Treatment In Women In Rural Regions Of Andhra Pradesh, Kiranpreet Kaur 4198353

UROP Posters

Despite efforts of Vision 2020 in India, the Andhra Pradesh Eye Disease Study (APEDS) extrapolated, in 2000, approximately 18.7 million blind people in India and also, projected an increase to 31.6 million blind people by 2020. Within the state Andhra Pradesh itself, preventable corneal blindness increased to 1.84% from 1.5% in the late 1980s.

Numerous public health studies have been conducted to outline factors that cause and preclude treatment of avoidable corneal blindness in the India. Conclusively, the escalation of corneal blindness can be largely attributed to personal, social, and economic barriers in utilizing available eye-care services. However, due to …

Social Determinants Of Maternal And Child Undernutrition In Cambodia: A Systematic Review, Pheak Chhoun, Khuondyla Pal, Sreymom Oy, Candice Collins, Sovannary Tuot, Siyan Yi

Background: Maternal and child undernutrition is one of the major contributors to the increasing of overall disease burden and mortality in the globe and Cambodia. Therefore, a systematic literature review was conducted to identify social determinants of maternal and child undernutrition in Cambodia.

Methods: Systematic literature search was performed through journal databases including ProQuest Central, Scopus, PubMed, Medline (Ovid), Google scholar, and World Health Organization Statistical Information System (WHOSIS). Keywords were used to search for literature in English published from 2003 to 2015. Content analysis was conducted among final selected papers.

Results: In total, 25 articles met …