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Intergenerational (im)mobility in a developing economy context: Is the social elevator broken?
No full textThere is an extensive literature available on intergenerational social and educational mobility in developed countries, but the evidence is still scant in developing countries. In the existing literature, household background has been predicted as a significant determinant of individuals’ current and future social status because it influences almost every aspect of their lives. We examine various channels through which socioeconomic background and other household and individual characteristics affect individuals’ educational and social opportunities in a developing economy, Pakistan. To accomplish the objectives, we have used a rich dataset: the Pakistan Standards of Living Measurement (PSLM) survey 2019-20, which contains information on individuals and their real parents. The empirical analysis highlights that the level of parents’ education is more relevant than the level of parents’ occupational skills in individuals’ social and educational opportunities
Penile human papillomavirus prevalence in circumcised sexual minority men living with and without HIV
No full textObjective: Understanding the burden of penile human papillomavirus (HPV) among high-risk groups is essential to inform tailored prevention strategies to reduce HPV-related morbidity. We estimated the prevalence of penile HPV and its association with HIV among circumcised sexual minority men (SMM). Design: A cross-sectional study from a community-based cohort of SMM with and without HIV in Nigeria. Methods: Penile swabs were genotyped with a next-generation sequencing assay for any and high-risk HPV (HPV16/18/31/33/35/39/45/51/52/56/58/59/68). HIV status was ascertained using rapid diagnostic tests. Multivariable logistic regression models estimated the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between HIV and any and high-risk penile HPV. Results: Among 498 participants, median age was 24 (interquartile range: 22-28) years and 70.5% (n=351) were living with HIV. The prevalence of any (n=362) and high-risk (n=239) penile HPV was 72.7% [95% confidence interval (95% CI): 68.6-76.4] and 48.0% (95% CI: 43.6-52.4), respectively. The most common high-risk HPV types were 16, 51, 45, and 18, while the most common low-risk types were 6 and 11. HIV was significantly associated with increased odds of any penile HPV (aOR 1.93, 95% CI: 1.20-3.12). Similar to any HPV, the association of HIV with high-risk penile HPV trended in the positive direction (aOR 1.45, 95% CI: 0.96-2.27), but it was not statistically significant. Conclusion: Penile HPV and HIV were highly prevalent among circumcised SMM in Nigeria. The most prevalent strains were vaccine-preventable, highlighting the need to prioritize HPV vaccination for boys as an additional strategy to prevent HPV-related morbidities
Effects of preconception nutrition interventions on pregnancy and birth outcomes in South Asia: A systematic review
No full textUndernutrition amongst reproductive age women, low birth weight, small for gestational age and preterm birth present significant health burdens in South Asia which interventions in pregnancy alone have not resolved. Effectiveness of preconception nutrition interventions is not well-documented. This systematic review summarises evidence on the effect of preconception nutrition interventions on pregnancy and birth outcomes in South Asia. We found highly heterogeneous evidence across four micronutrient supplementation, two food supplementation, and three complex interventions trials. Preconception micronutrient supplementation alone did not affect birth size, but food supplementation was effective with and without multiple micronutrients, especially when initiated at least 90 days before conception. Combined health, nutrition, psychosocial care, and WaSH interventions addressing determinants at multiple levels were most effective. However intensive delivery by project employees poses problems for scale-up. More robust South Asian preconception intervention trials to identify scalable interventions that are effective in real-world delivery settings are needed
Community-based approaches to promote uptake of Sulfadoxine-Pyrimethamine for intermittent preventive treatment of malaria in pregnancy: Midline findings from Kisumu and Migori Counties—Evidence brief
Get PDFEthiopia Humanitarian Violence Against Children and Youth Survey, 2024: Data-to-Action workshop report
Get PDFThe Government of Ethiopia’s Refugees and Returnees Service (RRS) officials, various government ministry delegates, representatives from International and national Non-Governmental Organisations, UN bodies, and various delivery partners, came together for a Data to Action (D2A) workshop in Addis Ababa from November 19th to 21st, 2024. During this workshop, participants prioritized violence prevention and response activities, directly informed by the HVACS data. This was achieved by translating the Ethiopia HVACS findings into key indicators that were then mapped into actionable next steps by linking this data to the INSPIRE: Seven Strategies for Ending Violence Against Children technical package and the Child Protection Minimal Standards (CPMS). The outcome of this D2A workshop, contextualized to activities conducted in the country, was data-driven, evidence-based recommendations for Ethiopia, with the aim of preventing and responding to violence against children in humanitarian settings. These priorities complemented existing implementation plans, drawing on recent and robust evidence specifically from refugee populations
Revising the definition of demand satisfied for modern methods of family planning: A cross-sectional study to explore incorporating person-centered constructs of demand, choice, and satisfaction
No full textSeveral challenges to validity have been identified with standard approaches used to measure demand satisfied for modern methods of family planning. This study explored construct validity of the widely used indicator for demand satisfied by comparing the standard definition to alternative definitions of the indicator highlighting dimensions of women\u27s own perceived demand, choice, and satisfaction. This cross-sectional study of women aged 15–49 years was conducted in Argentina (n = 1492), Ghana (n = 1600), and India (n = 1702) using a two-staged random sampling design. Women were directly asked about their: 1) demand, whether they wanted to use a contraceptive method to prevent pregnancy; 2) choice, whether they had autonomy in decision-making during their last family planning visit; and 3) satisfaction, whether they were satisfied with their method. The values of the standard and alternative indicators were compared. Convergent validity was assessed using logistic regression to explore the association between indicator definition and use of a preferred contraceptive method. In Argentina and India, the percentage of women with demand satisfied after incorporating constructs of demand, choice, and satisfaction was substantially lower than that obtained using the standard definition-a reduction of ∼70% in Argentina and ∼40% in India. Women who were categorized as having their demand satisfied for family planning according to the person-centered dimensions of the alternative indicator were significantly more likely to be using their preferred method of contraception in all three countries (OR: 7.7, 95% CI: 5.31-11.07 in Argentina, OR: 4.83, 95% CI: 2.27-10.27 in Ghana, and OR: 2.07 95% CI: 1.11-3.86 in India) compared to those whose demand wa satisfied by only the standard indicator definition. Revising the definition of demand satisfied to reflect the principles of person-centered care offers an opportunity to improve construct validity by ensuring that global measurement efforts align with women\u27s reproductive rights
Demographic, social and health system factors associated with maternal mortality in Pakistan: A nested case-control study
No full textBackground: Pakistan has experienced a significant reduction in maternal mortality with a decline of 33 percent between 2006 and 2019. However, the country still grapples with a high number (186 per 100,000 live births) of maternal deaths each year. This study aims to identify socio-demographic and health system related factors associated with maternal mortality. Methods: Using the nested case-control design, we conducted an in-depth analysis of Pakistan Maternal Mortality Survey (PMMS) 2019. We identified 147 maternal deaths occurring within three years prior to the PMMS 2019 as “cases” and 724 women who gave birth and were alive during the same period as “controls”. Socio-demographic characteristics of cases and controls were compared, and multivariate regression was employed to investigate the predictors of maternal mortality in Pakistan. Results: Cases and controls were similar on access to antenatal care (ANC) and ANC provider but differed on age, education, number of pregnancies, type of delivery, tetanus toxoid vaccination during last pregnancy, and contraceptive usage. A higher proportion of cases had deliveries by skilled birth attendants (83% compared to 63% among controls) while home deliveries were more common among controls (32% compared to 25% among cases). Odds of maternal death were lowest among women aged 20–29 years (odds ratio–OR: 0.5; 95% CI 0.23–1.07) and those with secondary or higher education (OR: 0.35; 95% CI 0.17–0.74). Surprisingly, deliveries attended by skilled birth attendants were associated with higher odds of maternal death (OR: 4.07; 95% CI 2.19–7.57) compared to those who were not. Conclusion: This study identifies secondary or higher maternal education, having had tetanus injection during the last pregnancy, ever-used contraception or being in the age group of 20–29 years were factors associated with lower risk of maternal mortality. Conversely, skilled birth attendance increases the risk of maternal death in Pakistan. Further investigation is needed into the determinants of high maternal mortality
Consensus recommendations for measuring the impact of contraception on the menstrual cycle in contraceptive clinical trials
No full textObjective: We sought to develop consensus recommendations for measurement and analysis of data on contraceptive-induced menstrual changes (CIMCs) in contraceptive clinical trials. We built upon previous standardization efforts over the last 50 years and prioritized input from a variety of global experts and current regulatory authority guidance on patient-reported outcomes. Study Design: We completed a formal consensus-building process with an interdisciplinary group of 57 experts from 30 organizations and 14 countries in five global regions who work across academia, nonprofit research organizations, the pharmaceutical industry, and funding agencies. Smaller topical working groups drafted and revised recommendations. Results: We developed 44 consensus recommendations, including research approaches to establish the evidence for future improvement in the measurement and analysis of CIMC data and guidance for investigators to implement presently. Priority recommendations call for simplification of terminology to make measurement accessible and patient-centered, accounting for intrinsic and extrinsic factors that may impact outcomes during study design and recruitment, standardized data collection of primary CIMC and acceptability outcomes, and harmonized approaches for analysis of these data, including addressing missing data. Conclusion: By virtually convening a large group of global experts working across disciplines and sectors via a formal methodology, we developed consensus recommendations that will improve the current and future measurement and analysis of CIMC data in contraceptive clinical trials. Using these standardized approaches will permit valid and reliable contraceptive product labeling on CIMC outcomes that matter to users and greater comparability across trials that can inform clinical guidance and contraceptive counseling
Development and validation of a multidimensional intravaginal ring acceptability scale among US women and their male partners
No full textObjective: Intravaginal rings (IVRs) are marketed or in development for contraception and other indications. We sought to develop and validate the IVR Acceptability Scale (IVR-AS) as a multidimensional, standardized tool for assessing IVR acceptability among end-users in the United States. Methods: Scale items reflect specific aspects of IVR acceptability for women and male partners. Response options range from 1 (not-at-all acceptable) to 5 (highly acceptable). We evaluated the IVR-AS within a randomized, crossover clinical trial of three nonmedicated silicone IVRs of differing external diameters (46, 56, 66 mm) in heterosexual couples who used each for ~30 days, then completed a self-administered survey. We conducted exploratory factor analysis and multivariable regression to assess convergent validity. Follow-up in-depth interviews with all participants explored scale salience. Results: Twenty-four couples participated (mean age 27). The final 19-item women\u27s scale (Cronbach\u27s alpha = 0.93) included six subdimensions: ease of use; experience and sensation; effect on sexual desire/engagement, and effect on vaginal sex (all alphas \u3e 0.78). The final eight-item men\u27s scale comprised two subdimensions: effect on sexual desire/engagement and effect on vaginal sex (all alphas \u3e 0.89). For both sexes, higher overall/subdimension scores were consistently associated with favorable assessments of the ring, for example, ease of insertion/removal; adherence (most p \u3c 0.001). The 46/56 mm IVRs had higher overall and subdimension scores than the 66 mm IVR (most p \u3c 0.001). Qualitative reports reinforced the salience of scale subdimensions and item content. Conclusion: The IVR-AS captures multiple dimensions of IVR acceptability among women and their partners. The scales demonstrated excellent reliability and convergent validity. Further validation is warranted in future studies
Preconception malnutrition among women and girls in south Asia: Prevalence, determinants, and association with pregnancy and birth outcomes
No full textThis review highlights the growing double burden of malnutrition among women of reproductive age in South Asia. Using nationally-representative survey data, we highlight that the prevalence of overweight now exceeds that of underweight, while anaemia remains persistently high despite intervention efforts. Underweight and anaemia are more common among unmarried women, whereas overweight is more prevalent among parous women, underscoring the need for life-stage-specific preconception nutrition programs. In our systematic review, micronutrient deficiencies vary widely between and within countries, reflecting regional disparities in nutritional status and inconsistencies in diagnostic methods. Associations of preconception underweight, overweight, anaemia and micronutrient deficiencies with health, nutrition, socio-demographic, and WASH indicators are mixed, emphasising the need for tailored, context-specific interventions. The lack of longitudinal studies limits our understanding of associations between preconception nutritional status and subsequent birth outcomes, underscoring the need for comprehensive, longitudinal studies across South Asia to inform and monitor targeted nutrition programs