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Use of at-home sperm concentration testing in a male hormonal contraceptive efficacy clinical trial
No full textOzone-related acute excess mortality projected to increase in the absence of climate and air quality controls consistent with the Paris Agreement
No full textShort-term exposure to ground-level ozone in cities is associated with increased mortality and is expected to worsen with climate and emission changes. However, no study has yet comprehensively assessed future ozone-related acute mortality across diverse geographic areas, various climate scenarios, and using CMIP6 multi-model ensembles, limiting our knowledge on future changes in global ozone-related acute mortality and our ability to design targeted health policies. Here, we combine CMIP6 simulations and epidemiological data from 406 cities in 20 countries or regions. We find that ozone-related deaths in 406 cities will increase by 45 to 6,200 deaths/year between 2010 and 2014 and between 2050 and 2054, with attributable fractions increasing in all climate scenarios (from 0.17% to 0.22% total deaths), except the single scenario consistent with the Paris Climate Agreement (declines from 0.17% to 0.15% total deaths). These findings stress the need for more stringent air quality regulations, as current standards in many countries are inadequate
Vulnerability to sexually transmitted infections (STI) / Human Immunodeficiency Virus (HIV) among adolescent girls and young women in India: A rapid review
No full textLimited evidence is available on the vulnerability of Adolescent Girls and Young Women (AGYW) to sexual risk behaviour and STI/HIV. Though there are almost no statistics available on vulnerability, related literature suggests that AGYW have low awareness about sexual risk behaviour/ transmission and the prevalence of STI/HIV, making them vulnerable. We conducted a rapid review of peer-reviewed studies addressing transmission network, prevalence, incidence awareness, common determinants of sexual risk behaviour/STI/HIV, health-seeking behaviour and existing interventions addressing the situation among AGYW (age 15–24) to inform the evidence gap in this crucial area of research. We registered the study in PROSPERO (CRD42023403713). We developed detailed inclusion/exclusion criteria, searched JSTOR, PubMed, Google Scholar, Science Direct and Population Council Knowledge Commons databases and followed the guidance from Cochrane Rapid Review to develop the rapid review. We also searched the bibliography of the included studies. We included the English language peer-reviewed quantitative, qualitative, mixed method studies published from Jan 1 2000 to Mar 31 2023. Six reviewers extracted data, and the seventh reviewer independently assessed the quality. Ninety-six studies met the inclusion criteria. We used descriptive statistics and narrative synthesis methods for data analysis. We also conducted a Risk of Bias Assessment (RoB) to check the quality of the included studies. Inadequate literature was found on the transmission network. Prevalence and awareness of STI/HIV are low among AGYW. However, Female Sex Workers, sex-trafficked women or drug users in this age group suffer more. Age, education, income, relationship dynamics with spouses/partners, multiple partners, and substance use are crucial in determining STI/HIV. Traditional sources of health seeking are more popular than formal sources because of social stigma. Mass media campaigns, community mobilization programs, and life skills training programs increase awareness about HIV, condom use and self-efficacy. The inclusion of only English language studies and not conducting meta-analysis because of high heterogeneity are some of the limitations of the study
Impact of DREAMS interventions on attitudes towards gender norms among adolescent girls and young women: Findings from a prospective cohort in Kenya
No full textThe DREAMS partnership aims to deliver a comprehensive package to reduce HIV incidence among adolescent girls and young women (AGYW), including through shifting gender norms. We evaluate DREAMS’ effect on attitudes towards gender norms in two Kenyan settings. AGYW aged 15–22 in Nairobi (n = 852) and Gem (n = 761) were randomly selected for cohort enrolment in 2017–18 and followed-up to 2019. We described the proportion of AGYW and their male peers with equitable attitudes towards gender norms, using an adapted version of the GEM scale. We estimated the association between self-reported invitation to DREAMS (in 2017–18) and AGYW’s attitudes towards two dimensions of gender norms, and then applied a causal inference framework to estimate the difference in the proportion of AGYW with equitable attitudes under the counterfactual scenarios that all versus none were DREAMS beneficiaries. We estimated that overall, 90.2% versus 87.1% of AGYW would have equitable norms around sexual and reproductive health decision-making in Nairobi if all versus none were DREAMS beneficiaries (+3.1; 95%CI:-2.5, +9.0). In Gem, we estimated a risk difference of +1.0 (89.6% vs 88.6%, 95%CI: -3.6,+5.6). There was no evidence for an effect of DREAMS on attitudes towards violence-related norms (Nairobi: 82.7% vs 82.2%, +0.5; 95%CI: -5.3,+6.5; Gem: 44.3% vs 48.2%, -3.9; 95%CI: -11.7,+3.0). We found no evidence of an impact of DREAMS invitation on individual attitudes towards gender norms. In some cases, equitable attitudes at enrolment left limited scope for improvement, and additional effort may be required to shift inequitable violence attitudes among both AGYW and their male peers
Exploring the implementation of an SMS-based digital health tool on maternal and infant health in informal settlements
No full textBackground: The rapid urbanization of Kenya has led to an increase in the growth of informal settlements. There are challenges with access to maternal, newborn, and child health (MNCH) services and higher maternal mortality rates in settlements. The Kuboresha Afya Mitaani (KAM) study aimed to improve access to MNCH services. We evaluate one component of the KAM study, PROMPTS (Promoting Mothers through Pregnancy and Postpartum), an innovative digital health intervention aimed at improving MNCH outcomes. PROMPTS is a two-way AI-enabled SMS-based platform that sends messages to pregnant and postnatal mothers based on pregnancy stage, and connects mothers with a clinical help desk to respond and refer urgent cases in minutes. Methods: PROMPTS was rolled out in informal settlements in Mathare and Kawangware in Nairobi County. The study adopted a pre-post intervention design, comparing baseline and endline population outcomes (1,416 participants, Baseline = 678, Endline = 738). To further explore PROMPTS\u27s effect, outcomes were compared between endline participants enrolled and not enrolled in PROMPTS (738 participants). Outcomes related to antenatal (ANC) and postnatal (PNC) service uptake and knowledge were assessed using univariate and multivariate linear and logistic regression. Results: Between baseline and enldine, mothers were 1.85 times more likely to report their babies and 1.88 times more likely to report themselves being checked by a provider post-delivery. There were improvements in moms and babies receiving care on time. 45% of the 738 endline participants were enrolled in the PROMPTS program, with 87% of these participants sending at least one message to the system. Enrolled mothers were 2.28 times more likely to report completing four or more ANC visits relative to unenrolled mothers. Similarly, enrolled mothers were 4.20 times more likely to report their babies and 1.52 times more likely to report themselves being checked by a provider post-delivery compared to unenrolled mothers. Conclusions: This research demonstrates that a digital health tool can be used to improve care-seeking and knowledge levels among pregnant and postnatal women in informal settlements. Additional research is needed to refine and target solutions amongst those that were less likely to enroll in PROMPTS and to further drive improved MNCH outcomes amongst this population
Patterns and drivers of maternal personal exposure to PM\u3csub\u3e2.5\u3c/sub\u3e in informal settlements in Nairobi, Kenya
No full textThere is limited data on personal exposure to fine particulate matter (PM2.5) for mothers in informal settlements in Africa. Identifying and characterizing the sources of exposure to PM2.5 for this population is key to finding potential solutions for mitigating air pollution exposures. As part of the USAID-funded Kuboresha Afya Mitaani Urban Maternal, Newborn and Child Health project in Nairobi, Kenya, this study aimed to (1) characterize and map environments that contribute to fine particulate matter (PM2.5) exposure for mothers and infants and (2) determine which factors drive exposure to PM2.5. Mothers were enrolled and measured for 24 hours with PM2.5 monitors and GPS loggers in two informal settlements in Nairobi (Dagoretti and Starehe), with complete data received from 73 participants. Two ambient PM2.5 monitors were also installed in each of the respective communities. Time-activity surveys were administered following the monitoring period. Mean daily exposures were 39.9 and 45.5 µg m−3 in Dagoretti and Starehe, respectively, with 60% of samples exceeding the annual WHO Annual Interim-1 Target of 35 µg m−3. Normal daily activities such as sleeping, resting, running errands, and visiting with friends constituted over three-quarters of exposure sampling time. These activities were not associated with elevated PM2.5 exposures, and generally tracked diurnal ambient patterns (morning and evening peaks). Personal exposures, however, did peak higher than ambient in the evenings when cooking was most common, and cooking with wood or charcoal was associated with higher PM2.5 personal exposures (daily mean of 54.2 µg m−3 [n = 16], compared to 40.3 µg m−3 for those who used gas, liquid fuels or electricity [n = 57]). These results suggest that transitioning households to cleaner fuels, such as electricity, LPG, or ethanol, would be the most promising intervention that could rapidly reduce exposures of mothers in informal settlements where biomass use is common. At the same time, larger-scale sectoral efforts are needed to bring ambient PM2.5 concentrations, and thus the overall population exposures, closer to WHO guidelines
Correlates of adherence to oral and vaginal pre-exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) participating in the MTN-034/REACH Trial
No full textWe evaluated correlates of adherence to PrEP, including daily oral tenofovir disoproxil fumarate in combination emtricitabine (oral FTC/TDF) and the monthly dapivirine ring (ring)among adolescent girls and young women (AGYW) in the MTN-034/REACH study. We enrolled 247 AGYW aged 16–21 years in South Africa, Uganda and Zimbabwe (ClinicalTrials.gov: NCT03074786). Participants were randomized to the order of oral FTC/TDF or ring use for 6 months each in a crossover period, followed by a 6-month choice period. We assessed potential adherence correlates—individual, interpersonal, community, study, and product-related factors—quarterly via self-report. We measured biomarkers of adherence monthly; high adherence was defined as \u3e 4 mg dapivirine released from returned rings or intracellular tenofovir diphosphate levels ≥ 700 fmol/punch from dried blood spots (DBS). We tested associations between correlates and objective measures of high adherence using generalized estimating equations. High adherence to oral FTC/TDF was significantly associated with having an older primary partner (p = 0.04), not having exchanged sex in the past 3 months (p = 0.02), and rating oral FTC/TDF as highly acceptable (p = 0.003). High ring adherence was significantly associated with unstable housing (p = 0.01), disclosing ring use to a male family member (p = 0.01), and noting a social benefit from study participation (p = 0.03). All associations were moderate, corresponding to about 6%–10% difference in the proportion with high adherence. In our multinational study, correlates of adherence among African AGYW differed for oral FTC/TDF and the ring, highlighting the benefit of offering multiple PrEP options
Leaving No One Behind: Fulfilling the Promise of Education for Pregnant and Parenting Girls in sub-Saharan Africa
Get PDFCommunity Engagement: A Bridge to Increasing Uptake of IPTp-SP to Prevent Malaria in Pregnancy
Get PDFUganda Humanitarian Violence Against Children and Youth Survey, 2022: Summary Report
Get PDFViolence Against Children (VAC) refers to all forms of abuse or maltreatment of people under the age of 18 years. The Violence Against Children and Youth Surveys (VACS), led by national governments with technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) as part of the Together for Girls partnership, have documented the magnitude and prevalence of physical, emotional, and sexual violence against children in more than 20 low- and middle-income countries, with a view to informing national prevention and response programs. Despite the precedent for understanding the extent of VAC from the perspectives of adolescents and pre-adolescent children, interest in systematic documentation of similar experiences of children in humanitarian settings is just emerging, following the development of guidance for the implementation of VACS in such contexts. This report presents key findings from the first VACS conducted exclusively in a humanitarian context—specifically, in refugee settings in Uganda. The survey is referred to as the Uganda Humanitarian VAC Survey (HVACS)