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Informational materials: Dual prevention pill
Get PDFInformational materials being used in a dual prevention pill study in South Africa
\u3ci\u3eTrichomonas vaginalis\u3c/i\u3e and spontaneous preterm birth in a high-risk obstetric cohort in Atlanta, GA
No full textBackground: Trichomonas vaginalis (TV) is the most prevalent nonviral sexually transmitted infection globally, but routine screening is not recommended in HIV-negative individuals. There is a significant racial/ethnic health disparity in TV infection rates. Evidence regarding the association between TV and adverse perinatal outcomes is conflicting, but a recent large meta-analysis found a modest increased risk of preterm birth with TV infection (odds ratio, 1.27; 95% confidence interval, 1.08-1.50). The current study was undertaken to evaluate whether TV infection increases the risk of spontaneous preterm birth (sPTB) in a high-risk obstetric cohort in Atlanta, GA. Methods: We conducted a retrospective cohort study of women delivering at a safety-net hospital in Atlanta between July 2016 and June 2018. Women delivering a singleton live fetus at \u3e20 weeks\u27 gestation were included. The diagnosis of TV was by nucleic acid amplification testing. The outcome of interest was sPTB before 37 weeks\u27 gestation. Multivariable Cox proportional hazards modeling was used to estimate the effect of TV on sPTB, controlling for confounding variables, including clinical and demographic characteristics. Several sensitivity analyses were undertaken. Results: There were 3723 deliveries during the study period, and approximately half (46%) were screened for TV with nucleic acid amplification testing. After exclusions, the analytic cohort included 1629 women. Median age was 26 years (interquartile range, 22-31 years), and 70% of participants were listed as non-Hispanic Black in the electronic medical record. The prevalence of TV was 16% (n = 257). The sPTB rate was 7% (n = 112). In multivariable Cox proportional hazards modeling, TV infection was not associated with a statistically significantly increased risk of sPTB (hazard ratio, 1.34; 95% confidence interval, 0.84-2.13; P = 0.22). Factors associated with sPTB included history of PTB, adequate plus or transfer of prenatal care (vs. adequate/intermediate prenatal care utilization using the Kotelchuck index), recreational substance use, and Chlamydia trachomatis diagnosed during the current pregnancy. Results were not substantively different in sensitivity analyses. Conclusions: The prevalence of TV was high in this cohort. Its infection was not associated with a statistically significantly increased risk of sPTB. Nevertheless, the magnitude of effect is consistent with prior meta-analyses
Qualitative evaluation of Breakthrough ACTION/Nigeria’s community capacity strengthening approach to sustaining integrated social and behavior change programming: Phase I
Get PDFTo ensure the maintenance and sustainability of social and behavior change (SBC), Breakthrough ACTION/Nigeria is implementing a phased, performance-based community capacity strengthening (CCS) approach that focuses on engaging existing community leaders and structures—namely ward development committees—to increase community self-efficacy, coordinate and support the health ecosystem in general, and to ensure sustained community-level activities supporting behavior change and positive social norms for improved health outcomes. Using a qualitative approach, Breakthrough RESEARCH assessed early successes, challenges, and opportunities for Breakthrough ACTION/Nigeria’s CCS Phase 1 approach in selected wards of the Bauchi and Sokoto states in Nigeria
Asset and consumption gradient of health estimates in India: Implications for survey and public health research
No full textThe wealth index based on household assets and amenities is been increasingly used to explain economic variations of health outcomes in the developing countries. While the variables used to compute the wealth index are easy to collect and time- and cost-effective, the wealth index tends to have an urban bias, uses arbitrary weighting, does not provide per capita measures and is a poor measure of inequality. We used micro data from two of the large-scale population-based surveys, the Longitudinal Ageing Study in India, 2017–18 and the India Human Development Survey, 2011–12 that covered over 42,000 households each and collected data on household consumption, assets and amenities in India. We examined the variations and inequality in health estimates by consumption per capita and asset-based measures in India. Descriptive statistics, logistic regression model, concentration index, and concentration curve were used in the analyses. | We found a weak association between monthly per capita consumption expenditure (MPCE) and wealth index in both the surveys. Some of the health conditions such as hypertension, cataract, refractive error, and diabetes tended to be underestimated in the bottom 40% of the population when economic well-being was measured using the wealth index compared to consumption. Socio-economic inequality in health outcome, inpatient and outpatient health services were underestimated when measured using the wealth index than when measured using MPCE. | We conclude that economic gradients of health by consumption and wealth index are inconsistent and that per capita consumption predicts health estimates better than the wealth index. It is recommended that public health research using population-based surveys that provide data on consumption and wealth index use per capita consumption to explain economic variations in health and health care utilization. We also suggest that the future rounds of the health surveys of National Sample Survey and the National Family and Health Surveys include an abridged version of the consumption schedule to predict better economic variations in health and health care utilization in India
The prevalence of domestic servitude among child domestic workers in Addis Ababa, Ethiopia: Research findings
Get PDFIt is estimated that there are 17.2 million child domestic workers globally, most of whom are girls. Research related to this marginalized group is limited, with most at a small scale or subsumed in other topics, such as domestic workers generally. The dearth of evidence limits awareness about girls in such circumstances and inhibits the design and implementation of context-appropriate policy and program responses. This mixed-method study is one of the few large-scale studies to examine child domestic work, including its prevalence, the entry and experience of girls in this work, and levels of human trafficking, hazardous work, and illegal child labor. The study, which took place in low-income areas of Addis Ababa, Ethiopia, takes into account ambiguities in distinguishing child domestic workers, especially when workers are distant family members or children considered to be fostered. For this report, “child domestic workers” include those who self-identify as domestic workers, and girls who report a minimum of 14 hours of domestic work undertaken per week and are not living with conjugal family members. The majority of girls in child domestic work are migrants and come from extremely poor backgrounds
A conceptual framework for understanding child marriage, marriage markets, and marriageability
No full textThe term ‘marriageability’ is used frequently in child marriage literature but is rarely defined. We propose a conceptual framework to define marriageability and use qualitative case studies to illustrate how ideas about marriageability contribute to child marriage. Pressure to capitalize on a girl’s marriageability before it declines in order to secure the ‘best’ partner may explain why child marriage persists. We find that marriageability involves both eligibility—or perceived readiness for marriage—as well as desirability or ‘value’ on the marriage market. We propose that understanding marriageability in context, particularly in countries with limited evidence on interventions to address child marriage, is essential for suggesting ways interventions may critically examine notions of marriageability and disrupt pathways to child marriage
In vitro drug release, mechanical performance and stability testing of a custom silicone elastomer vaginal ring releasing dapivirine and levonorgestrel
No full textWe have previously reported a multipurpose silicone elastomer vaginal ring providing sustained release of dapivirine (an antiretroviral) and levonorgestrel (a progestin) for HIV prevention and hormonal contraception. During initial development, issues arose due to reaction between the ethynyl group in the levonorgestrel molecule and the hydride-functionalised polydimethylsiloxane components in the silicone elastomer formulation. This unwanted reaction occurred both during and to a lesser extent after ring manufacture, impacting the curing process, the mechanical properties of the ring, and the in vitro release of levonorgestrel. Recently, we reported custom silicone elastomer grades that minimise this reaction. In this follow-on study, we describe the manufacture, in vitro drug release, mechanical, and pharmaceutical stability testing of ring formulations prepared from a custom silicone elastomer and containing 200 mg dapivirine and 80, 160, 240 or 320 mg levonorgestrel. The rings showed mechanical properties similar to marketed ring products, sustained in vitro release of both drugs over 30 days in quantities deemed clinically relevant, offered acceptable assay values, and provided good product stability over 15 weeks at 40 °C and 75% relative humidity
Acceptability and preference for 3-month versus 1-month vaginal rings for HIV-1 risk reduction among participants in a Phase 1 trial
No full textBackground: The monthly dapivirine vaginal ring provides partial protection against HIV, and a longer duration ring may reduce user burden and improve adherence. We examined acceptability and preference for 3-month versus 1-month rings for HIV-1 risk reduction in a phase 1 clinical trial. Materials and Methods: In Microbicide Trials Network-036/International Partnership for Microbicides 047, 49 HIV-negative participants aged 18-45 were randomized to one of two 3-month rings or the 1-month ring. Acceptability ratings were collected at enrollment, week 4, and study exit (week 13). At exit, ring preference was assessed quantitatively among all participants and a randomly selected subset of 24 participants completed in-depth interviews. Quantitative and qualitative findings were integrated to explore factors influencing acceptability and preference. Results: Acceptability of each ring was initially moderate and increased during the trial. Ratings were lower in the 3-month ring arms than the 1-month arm at each time point, including baseline. Most participants (34/47; 72%) preferred a 3-month ring at exit; however, this proportion was significantly lower within some subgroups characterized by site, education, race/ethnicity, and experiences with ring use. Qualitative interviews revealed reservations about hygiene and safety of the 3-month ring, including discomfort with use during menses, but these were usually outweighed by its increased convenience. Conclusions: Both ring durations were highly acceptable at study exit. Although most participants preferred a 3-month ring, preference was more divided in certain subgroups, highlighting the benefit of offering different duration options. Providing additional support to address concerns about hygiene and safety may improve acceptability of a 3-month vaginal ring
Association between school dropouts, early marriages, childbearing, and mental health in early adulthood of women: Evidence from a cohort study in Bihar, India
No full textSchool dropouts, early marriages, and low age at childbearing are issues still prevalent in Indian states like Bihar, which may be responsible for poor mental health among young adults. The present study examined the effect of life-course events such as school dropouts, early marriages, and early childbearing on mental health status at later ages (23–28 years). Using data from the Understanding the Lives of Adolescents and Young Adults consisting of a 2360 adolescent (ages 15 – 19) girl cohort interviewed in 2007 and re-interviewed at ages 23 – 28 in 2016 from the state of Bihar, India, we applied ordinal logistic regression models in analyzing factors associated with mental health status. Women who never attended school, or dropped out from school, and who got married before age 19 showed a poorer mental health status in their young adulthood (22 – 28 years) compared to their respective counterparts who attended a school and who got married at age 19 or older. As compared to women who had a child before age 19, those who did not have any child, or who had children after 20 years of age were more likely to have poor mental health. Working women, high self-efficacy of women, and women who have decision-making power showed better mental health outcomes as compared to their respective counterparts. To enhance psychological well-being of young women, the study recommends continue education and delaying marriage as the programmatic keys with attention to improving young women’s autonomy and gender role attitudes and reducing societal pressure for bearing first child soon after marriage