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Addressing Marginalization and Invisibility Among Humanitarian Populations in the East and Horn of Africa
Get PDFLinking Research to Action for Children in Humanitarian Contexts: Synopsis of the 2022 Uganda Humanitarian Violence Against Children and Youth Survey (HVACS) Findings and Data-to-Action Workshop
Get PDFThe 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 (TfG) partnership, have documented the magnitude and prevalence of sexual, physical, and emotional VAC in more than 20 low- and middle-income countries, with a view to informing national prevention and response programs in development settings. This report presents key findings from the first-ever VACS conducted exclusively in a humanitarian context—specifically, in refugee settings in Uganda. The report couples these findings with proceedings of a dissemination workshop for humanitarian sector stakeholders to identify priorities and devise actions in response to the survey results along with what we know from existing literature
Do child marriage programs help girls weather shocks like COVID-19? Evidence from the More Than Brides Alliance Intervention
No full textThis paper contributes to the evidence base on the impact of the COVID-19 on child marriage prevalence and on the protective potential of girl-centred, community-level interventions in buffering communities against aggregate shocks. Drawing on data from repeat cross-sectional surveys completed with adolescent girls aged 12–19 in 609 villages in four states in India as a part of the More Than Brides Alliance impact evaluation, we examine whether the intervention appears to have impacted child marriage prevalence over its 5-year implementation period, whether the onset of COVID-19 affected ongoing trends in child marriage prevalence, and whether the intervention appeared to have buffered against increased child marriage risk resulting from the pandemic. Results show that significant differences emerged between treatment and control villages between midline and endline—and these differences were larger following the onset of COVID-19—suggesting both that the treatment was successful in preventing child marriage and that the intervention had a protective effect. Results suggest that girl-centred, community-based interventions can help communities to weather environmental shocks and protect girls against potential increased child marriage risk during times of acute crisis
Menstruation and adolescent girls\u27 daily lives in rural Upper Egypt
Get PDFThe Population Council conducted a qualitative study to understand the menstruation-related attitudes, practices, and perceptions that shape adolescent girls’ daily routines in rural upper Egypt communities, specifically Assiut and Sohag. The study relied on in-depth interviews with unmarried adolescent girls aged 13–16; focus group discussions with girls aged 13–16, mothers, fathers, and male siblings of adolescent girls; and key informant interviews with schoolteachers, doctors/nurses, pharmacists, and community leaders. “Period poverty” (lack of access to, or inability to afford period supplies) can be detected among adolescent girls in rural Assiut and Sohag. Lack of information and emotional and practical support before menarche, as well as limited access to accurate information and material resources during menstruation, translates into material and psychosocial deprivation for girls and compromises their health and well-being. Moreover, misconceptions about menstrual blood restricts their mobility and places them in a more vulnerable position. Such restrictions may adversely affect girls’ school attendance, limit their economic opportunities, and further exacerbate gender inequalities. A number of recommendations are made on policy, programmatic, and research fronts
Adherence, safety, and choice of the monthly dapivirine vaginal ring or oral emtricitabine plus tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis among African adolescent girls and young women: A randomised, open-label, crossover trial
No full textBackground: Half of new HIV acquisitions in Africa occur in adolescent girls and young women. Pre-exposure prophylaxis (PrEP) with oral tenofovir disoproxil fumarate plus emtricitabine or the monthly dapivirine vaginal ring is efficacious but has lower adherence and effectiveness among adolescent girls and young women. We aimed to assess product adherence, safety, and choice of oral PrEP compared with the dapivirine ring among African adolescent girls and young women. Methods: MTN-034/REACH was a randomised, open-label, phase 2a crossover trial among HIV-seronegative, non-pregnant adolescent girls and young women aged 16–21 years at four clinical research sites in South Africa, Uganda, and Zimbabwe. Participants were randomly assigned (1:1) to either the dapivirine ring or daily oral PrEP (200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate) for 6 months, then switched to the other product option for 6 months, followed by a third 6-month period in which participants were given a choice of oral PrEP, the dapivirine ring, or neither. Fixed block randomisation was used, stratified by site. The primary adherence endpoint was use of each product during the randomised periods, with high use defined as tenofovir-diphosphate concentrations greater than or equal to 700 fmol/punch (associated with taking an average of four or more tablets per week in the previous month) and greater than or equal to 4 mg dapivirine released from the returned ring (continuous use for 28 days in the previous month) based on residual drug concentrations. The primary safety endpoint was grade 2 or higher adverse events during each randomised period of 24 weeks of ring and oral PrEP. This trial is registered at ClinicalTrials.gov, NCT03593655. Findings: From Feb 6, 2019 to Sept 9, 2021, 396 adolescent girls and young women were screened, 247 of whom were enrolled and randomly assigned (6 months of the ring followed by 6 months of oral PrEP n=124; 6 months of oral PrEP followed by 6 months of the ring n=123). Median age was 18 years (IQR 17–19). 54 grade 2 or higher product-related adverse events were reported during oral PrEP and five during dapivirine ring use, with no product-related serious adverse events. High adherence was observed in 753 (57%) of the 1316 oral PrEP visits and 806 (57%) of the 1407 dapivirine ring visits. Four women acquired HIV during follow-up. Interpretation: Adherence was moderately high and similar between oral PrEP and the dapivirine ring with favourable safety and tolerability. Oral PrEP and the dapivirine ring are effective, safe, and well tolerated HIV prevention options for adolescent girls and young women who would benefit from a choice of PrEP formulations to meet their needs and preferences
National guidelines for data quality in surveys: An overview
No full textGood quality health, nutrition and demographic survey data are vital for evidence-based decision-making. Existing literature indicates system specific, data collection and reporting gaps that affect quality of health, nutrition and demographic survey data, thereby affecting its usability and relevance. To mitigate these, the National Data Quality Forum (NDQF), under the Indian Council of Medical Research (ICMR) - National Institute of Medical Statistics (NIMS) developed the National Guidelines for Data Quality in Surveys delineating assurance mechanisms to generate standard quality data in surveys. The present article highlights the principles from the guidelines for informing survey researchers/organizations in generating good quality survey data. It describes the process of development of the national guidelines, principles for each of the survey phases listed in the document and applicability of them to data user for ensuring data quality. The guidelines may be useful to a broad-spectrum of audience such as data producers from government and non-government organizations, policy makers, research institutions, as well as individual researchers, thereby playing a vital role in improving quality of health, nutrition and demographic data ecosystem
Does size matter? A randomized controlled trial to assess the impact of external diameter on adherence to 3 different intravaginal rings among 24 US couples
Get PDFBackground: Intravaginal rings (IVRs) are being developed as multipurpose prevention technologies (MPTs) for simultaneous HIV and pregnancy prevention. However, no empirical data exists to support the current 54-58mm size as ideal. Understanding the impact of IVR size on adherence is critical for developing a product that can be used correctly and consistently. Methods: We conducted a randomized, open-label, 3-way crossover trial comparing adherence, preference, and acceptability of 3 non-medicated silicone IVRs of differing external diameters: 46mm, 56mm and 66mm. 24 couples in Atlanta, GA and Bronx, NY were randomized to the sequence of IVR use, used each continuously for ~30 days. The primary objective was to compare ring adherence, defined as never having the IVR out of the vagina for \u3e 30 minutes in 24h. Women reported occurrence and duration of expulsions and removals via daily text. We summarized the proportion of days the IVR was removed, expelled, or out all day, and the proportion of women adherent to each IVR. We used mixed methods logistic regression models with random intercepts (per participant) to compare the probability of each event happening per day of IVR use, per IVR. Results: 23/24 couples completed the study. 78%, 75% and 59% of participants were adherent to the IVRs of diameter 46mm, 56mm and 66mm respectively (Table 1). The 46mm and 66mm IVR performed similarly, with more expulsions and 24h outages for the 66mm IVR. When adjusting for size and sequence, women had \u3e 15 times the odds of the 66mm IVR being out all day versus the 56mm IVR (15.7, 95% CI: 3.4, 72.6). Conclusions: External diameter of these non-medicated IVRs had a significant impact on frequency of removal and expulsion. Product developers should prioritize IVRs in the range of 46mm-56mm
Community-based empowerment program to delay marriage: Results from the More Than Brides Alliance intervention in India, Malawi, Mali and Niger
No full textThe More Than Brides Alliance (MTBA) implemented an intervention in India, Malawi, Mali and Niger from 2017 to 2020. The holistic community-based program included girls’ clubs focused on empowerment and sexual and reproductive health knowledge; work with parents and educators; community edutainment events; and local-, regional-, and national-level advocacy efforts related to child marriage. Using a cluster randomized trial design (India and Malawi), and a matched comparison design (Niger and Mali), we evaluated the effectiveness of the program on age at marriage among girls ages 12–19 in intervention communities. Repeat cross sectional surveys were collected at baseline (2016/7), midline after approximately 18 months of intervention (2018), and endline (2020). Impact was assessed using difference-in-difference (DID) analysis, adjusted for the cluster design. We find that the intervention was successful at reducing the proportion of girls ages 12–19 married in India (-0.126, p \u3c .001). Findings in the other countries did not show impact of the intervention on delaying marriage. Our findings suggest that the MTBA program was optimized to succeed in India, in part because it was built on an evidence base that relies heavily on data from South Asia. The drivers of child marriage in India may be substantially different from those in Malawi, Mali, and Niger and require alternate intervention approaches. These findings have implications for those designing programs outside of South Asia and suggest that programs need to consider context-specific drivers and whether and how evidence-based programs operate in relation to those drivers