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Cost-effectiveness analysis comparing integrated and malaria-only social and behavior change programming in Nigeria: Final report
Get PDFIn Nigeria, the Breakthrough ACTION project, funded by the United States Agency for International Development (USAID)/Nigeria, is working closely with the Nigerian government to improve the practice of priority health behaviors, with a focus on maternal, newborn and child health and nutrition, family planning and reproductive health, malaria, and tuberculosis. Within the broader program, Breakthrough ACTION uses different social and behavior change (SBC) approaches in different states. In northern Nigeria, Breakthrough RESEARCH compared the cost-effectiveness of the integrated SBC approach addressing multiple health areas in Kebbi and Sokoto states to a malaria-only approach in Zamfara. This cost-effectiveness study examined whether the additional cost required for an integrated SBC approach (as compared to a malaria-only approach) is a cost-effective investment. Additionally, this study examined malaria-specific impacts within an integrated SBC program compared to a malaria-only program
Examining the longitudinal relationship between intimate partner violence and couples’ marital quality in rural India
No full textMuch of the research on intimate partner violence (IPV) documents the negative impacts of violence on women, which are substantial. Less attention has been given to perceptions of the marital relationship given these experiences of violence. However, evidence suggests that many women affected by IPV within marriage remain in their relationships, particularly in contexts such as India, where divorce remains highly stigmatized. Understanding and supporting marital quality may need greater prioritization to support women who remain in relationships affected by violence. This study examines the association between IPV and marital quality among young married couples in rural India. We interviewed 1084 women and 1084 men at two time points (baseline, 18 months) in a western state in India and used multilevel mixed effects models to test the association between IPV and marital quality. We found that women’s experience of physical and sexual IPV was associated with poor marital quality at 18 months. Women’s experience of sexual IPV was also negatively associated with men’s self-reported marital quality at 18 months. Among men, spouse’s marital quality was positively associated with their own rating of marital quality. We also examined the reciprocal relationship between IPV and marital quality and found that women’s report of poor marital quality was associated with their future experience of physical IPV, sexual IPV, and emotional IPV. Taken together, these findings suggest that IPV interventions need to target marital quality to be effective. To do this, we would need to shift our lens from empowering individuals to empowering couples to work together to improve their relationships
Adaptation in Crisis: Understanding and Addressing the Needs of Adolescent Girls in Humanitarian Emergency Settings
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Adolescent wellbeing in humanitarian and fragile settings: Moving beyond rhetoric
No full textKey messages:- Adolescents are particularly vulnerable in humanitarian and fragile settings, where they often face high risk situations and may be forced to take on adult roles- Data are lacking on the specific needs of adolescents in these settings and how to improve their wellbeing- Greater investment is needed in adolescent specific strategies and in collecting disaggregated data by age, gender, sexual orientation, and disability status- Humanitarian and development sectors must work together to support the diverse needs of adolescents throughout their lives- Adolescents must be involved in the design, implementation, and evaluation of interventions to ensure meaningful engagemen
Measuring adequacy of the midwifery workforce using standards of competency and scope of work: Exploring the density and distribution of midwives in three low- and middle-income countries using cross-sectional and geospatial data
No full textBackground: A global midwifery shortage hampers the goal of ending preventable maternal/newborn mortality and stillbirths. Whether current measures of midwifery workforce adequacy are valid is unknown. We compare two measures of density and distribution of midwifery professionals to assess their consistency, and explore how incorporating midwifery scope, competency, and the adjusting reference population impacts this critical metric. Methods and Findings: We collected a census of midwives employed in eligible facilities in our study settings, (422 in Ghana; 909 in India), assessed the number practicing within the scope of work for midwifery professionals defined in the International Labor Organization International Standard Classification of Occupations, and whether they reported possessing the ICM essential competencies for basic midwifery practice. We altered the numerator, iteratively narrowing it from a simple count to include data on scope of practice and competency and reported changes in value. We altered the denominator by calculating the number of midwives per 10,000 total population, women of reproductive age, pregnancies, and births and explored variation in the indicator. Across four districts in Ghana, density of midwives decreased from 8.59/10,000 total population when counting midwives from facility staffing rosters to 1.30/10,000 total population when including only fully competent midwives by the ICM standard. In India, no midwives met the standard, thus the midwifery density of 1.37/10,000 total population from staffing rosters reduced to 0.00 considering competency. Changing the denominator to births vastly altered subnational measures, ranging from ~1700% change in Tolon to ~8700% in Thiruvallur. Conclusion: Our study shows that varying underlying parameters significantly affects the value of the estimate. Factoring in competency greatly impacts the effective coverage of midwifery professionals. Disproportionate differences were noted when need was estimated based on total population versus births. Future research should compare various estimates of midwifery density to health system process and outcome measures
Assessing the health, social, educational and economic impact of the COVID-19 pandemic on adolescents in low- and middle-income countries: A rapid review of the literature
No full textCOVID-19 has caused profound health, social, educational and economic devastation around the world, especially among the lives of adolescents in low- and middle-income countries. This paper looks at a wide array of outcomes impacting adolescents\u27 daily lives including health (mental, physical, sexual and reproductive health, vaccine perceptions and overlap between these topics), social relationships (family and peer), education and socio-economic disparities. Both scientific and grey literature between December 2019 and February 2022 were sought from PubMed, Google Scholar and organisations conducting research among adolescents, and coded. A total of 89 articles were included, 73% of which were peer-reviewed; 37% of the articles were from WHO\u27s Western Pacific region; 62% of the articles were cross-sectional; 75% were quantitative. Three major topics emerged in more than half the articles: mental health (72%), education (61%) and socio-economic ramifications (55%). However, there were regional differences in topics and many of them overlapped. The results indicate that, where there has been research, almost all findings have been linked to worse mental health during the pandemic. Overall, remote education was seen as a negative experience. The ramification of school closures on future aspirations, in particular early school leaving, highlights the importance of prioritising education during future pandemics based on the situation within the country. Gender and other disparities have made marginalised adolescents vulnerable to the economic ramifications of containment measures. Given the risks identified, there is a pressing need to put adolescents at the centre of establishing priorities for their health agenda for post-pandemic recovery