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Psychosocial influences on pregnancy and childbirth behaviours in north-western Nigeria: A cross-sectional analysis
No full textAntenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in north-western Nigeria. This study aimed to assess the psychosocial influences on pregnancy and childbirth behaviours in Nigeria. Data were from a cross-sectional population-based survey of randomly sampled women with a child under 2 years conducted in Kebbi, Sokoto and Zamfara states of north-western Nigeria in September 2019. Women were asked about their maternal health behaviours during their last pregnancy. Psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behaviour Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Among the 3039 sample women, 23.6% (95% CI: 18.0–30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8–20.1%) gave birth in a facility. Among women who did not attend ANC4+ times or have a facility-based delivery during their last pregnancy, the most commonly cited reasons for non-use were lack of perceived need (42% and 67%, respectively) and spousal opposition (25% and 27%, respectively). Women who knew any ANC benefit or the recommended number of ANC visits were 3.2 and 2.1 times more likely to attend ANC4+ times, respectively. Women who held positive views about health facilities for childbirth had 1.2 and 2.6 times higher likelihood of attending ANC4+ times and having a facility delivery, respectively, while women who believed ANC was only for sickness or pregnancy complications had a 17% lower likelihood of attending ANC4+ times. Self-efficacy and supportive spousal influence were also significantly associated with both outcomes. To improve pregnancy and childbirth practices in north-western Nigeria, Social and Behavioural Change programmes could address a range of psychosocial factors across cognitive, emotional and social domains which have been found in this study to be significantly associated with pregnancy and childbirth behaviours: raising knowledge and dispelling myths, building women’s confidence to access services, engaging spousal support in decision-making and improving perceived (and actual) maternal health services quality
Matching intent with intensity: Implementation research on the intensity of health and nutrition programs with women\u27s self-help groups in India
No full textIntroduction: In India, a large network of self-help groups (SHGs) implements interventions to improve women’s and children’s health and nutrition. There is growing evidence on the effectiveness of women’s group interventions to improve health but limited information on implementation intensity, including how often groups meet, for how long, and with whom, despite this often being cited as a key factor for success. We aimed to assess the implementation intensity of large SHG-based health and nutrition interventions with rural, low-income women, to inform program design, delivery, and measurement. Methods: We synthesized process data from surveys, meeting observations, and process evaluations across 8 maternal and child health and nutrition interventions in India. We examined the implementation intensity of 3 common intervention delivery channels: group meetings, home visits, and community-level activities. Results: SHG members spent approximately 30 minutes in monthly meetings discussing health or nutrition. SHG dissolution or limited participation in meetings was a common challenge. Beyond group meetings, home visits reached approximately 1 in 3 households with an SHG member. Pregnant and breastfeeding women’s participation in community events varied across interventions. Discussion: Interventions that aim to capitalize on existing networks of financial women’s groups not specifically formed for health and nutrition objectives, such as SHGs, will need to have an implementation intensity that matches the ambition of their health objectives: substantial changes in behavioral or mortality outcomes are unlikely to be achieved with relatively light intensity. Interventions that require sustained interactions with members to achieve health outcomes need to ensure adequate community and individual outreach to supplement group meetings, as well as improved participation through more intensive community mobilization approaches. Evaluations of group-based interventions should report on implementation intensity to support the interpretation of evaluation evidence and to inform further scale-up
Persistence of female genital mutilation/cutting in two Kenyan communities: What can we learn from change that falls short of abandonment?
No full textLiterature on dynamics of change in female genital mutilation/cutting (FGM/C) portray two common but conflicting views. On one side, FGM/C is seen as static and deeply entrenched, with parents lacking agency to interpret culture, evaluate options and adopt changes. An alternative perspective focuses on the fluidity of social norms, influencing whether and how FGM/C is practised. This study asks: in counties where FGM/C persists at high rates, Kisii and Narok, are there changes in the way that FGM/C is performed? and what drives these changes? In-depth interviews and focus group discussions were conducted to illuminate these questions. Data showed five ways that FGM/C practices have changed: (1) reduction in severity of cutting, (2) medicalised cutting, (3) performing FGM/C at younger ages, (4) cutting in secret, and (5) occasionally, abandonment of FGM/C. Messaging on health risks of FGM/C and fear of criminal punishment have motivated less severe cutting and medicalisation. Legislation has also driven the practice underground. Programmes aimed at ending FGM/C should create a critical dialogue on changes in norms with the intent of reducing stigmatisation of uncut girls and their families, and the ways cutting practices are shifting, thereby building on change that is already underway
Measuring potential interest in a postpartum contraceptive vaginal ring among breastfeeding women in India
No full textAccess to safe and effective contraception for postpartum women is an important priority in India, where the unmet need for postpartum contraception is high. In this paper, we estimate the potential market size in India for the progesterone vaginal ring (PVR), a novel user-controlled contraceptive method that offers additional contraceptive choice for lactating women. We integrated results of a one-year phase-3 multicenter clinical trial for the PVR conducted in India with an analysis of the National Family Health Survey (2015–16) and 2019 United Nations Population Division data to generate three estimates of potential market size for the PVR among postpartum breastfeeding women in India. We estimate the potential market size for the PVR ranges from a low estimate of 543,262 women to a high estimate of 1.3 million women, with a separate intermediate estimate of 737,460 women. Our analysis indicates the PVR could play an important role in decreasing unmet need among postpartum women in India, thereby reducing risks to mothers and children associated with short birth intervals, helping to prevent unintended pregnancies, and helping to address access-related issues heightened by the COVID-19 pandemic
MARK2 and MARK4 regulate Sertoli cell BTB dynamics through microtubule and actin cytoskeletons
No full textMARKs (microtubule affinity-regulating kinases) are non-receptor Ser/Thr protein kinases known to regulate cell polarity and microtubule dynamics in C. elegans, Drosophila, invertebrates, vertebrates and mammals. An earlier study has shown that MARK4 is present at the ectoplasmic specialization (EC) and blood-testis barrier (BTB) in the seminiferous epithelium of adult rat testes. Here, we report the function of MARK4 and another isoform MARK2 in Sertoli cells at the BTB. Knockdown of MARK2, MARK4 or MARK2 and MARK4 by RNAi using the corresponding siRNA duplexes without apparent off-target effects was shown to impair TJ-permeability barrier at the Sertoli cell BTB. It also disrupted microtubule (MT)- and actin-based cytoskeletal organization within Sertoli cells. Although MARK2 and MARK4 were shown to share sequence homology, they likely regulated the Sertoli cell BTB and MT cytoskeleton differently. Disruption of the TJ-permeability barrier following knockdown of MARK4 was considerably more severe than loss of MARK2, though both perturbed the barrier. Similarly, loss of MARK2 affected MT organization in a different manner than the loss of MARK4. Knockdown of MARK2 caused MT bundles to be arranged around the cell periphery, whereas knockdown of MARK4 caused MTs to retract from the cell edge. These differences in effects on the TJ-permeability barrier are likely due to the unique roles of MARK2 and MARK4 in regulating the MT cytoskeleton of the Sertoli cell
Examining roles, support, and experiences of community health workers during the COVID-19 pandemic in Bangladesh: A mixed methods study
No full textIntroduction: Understanding community health workers\u27 (CHWs) experiences of sustaining routine health care promotion and provision activities as well as their challenges in adopting new responsibilities within a dynamic context is critical. This study explored the roles and perspectives of CHWs within the government-led coronavirus disease (COVID-19) community health response in Bangladesh. Methods: We conducted a mixed methods study to explore the government\u27s response to COVID-19 and its association with community health programming through a telephone-based survey of 370 government-employed CHWs. We also conducted 28 in-depth interviews with policy makers, program managers, CHW supervisors, and CHWs. We conducted exploratory and regression analysis of survey data and qualitative analysis of interview data. Results: The majority of CHWs reported receiving training related to COVID-19, including community-based prevention strategies from government and nongovernment stakeholders. Access to infection prevention supplies differed significantly by CHW cadre, and perspectives on the provision of adequate supplies varied qualitatively. CHWs reported slight decreases in routine work across all health areas early in the pandemic, and a majority reported added COVID-19-related responsibilities as the pandemic continued, including advising on signs/symptoms in their communities and referring suspected cases of COVID-19 for advanced facility care. Regression analyses showed that government support and integration of CHWs into their response-particularly being trained on COVID-19-predicted CHW capacity to advise communities on symptoms and provide routine services. Discussion: Government-employed CHWs in Bangladesh continued to provide health education and routine services in their communities despite pandemic- and response-related challenges. Varied support and differential CHW cadre-specific effects on COVID-19 awareness building in the community, referral, and routine service provision merit attention in Bangladesh\u27s pluralistic community health system. While COVID-19 infection and government-mandated lockdowns restricted CHW mobility, the workers\u27 capacity to continue service provision and education can be leveraged in vaccination and surveillance efforts moving forward
Husbands’ concerns and experiences with the progesterone vaginal ring in three sub-Saharan African countries: A mixed methods study
No full textThe introduction of progesterone vaginal ring (PVR) in sub-Saharan Africa calls for insights on the product’s role in promoting women’s autonomy regarding their reproductive decision-making and behaviour. Such insights could inform the positioning of the method within family planning programmes in the region. In this paper, we explore husbands’ experiences with PVR as perceived by their wives and as reported by husbands of a subset of women users in Kenya, Nigeria, and Senegal. We discuss how such experiences might influence women’s rights and autonomy regarding their reproductive decisions and contraceptive behaviour. We use a mixed-methods approach drawing on data from quantitative interviews with 174 women and qualitative in-depth interviews with 10 husbands of a subset of the women in the three countries. The findings show that husbands appreciated PVR’s attributes relating to user-control (women could insert and remove the method themselves), ease of use, and non-interference with sex and flow of breast milk. Wives’ perceptions of their husbands’ experiences regarding PVR’s non-interference with sex were consistent with the husbands’ own reports. In addition, health care providers played important roles in supporting sustainable use of the method through giving information, counselling, and assisting women who experienced ring slippage to manage those challenges. The findings suggest that self-managed health technologies such as PVR could expand women’s choices and control over their reproductive decisions. The findings further suggest that sustainable use of such products could require linkages with appropriate health systems structures to address challenges with use if and when they arise
Fertility Transition in the Developing World
No full textThis open access book provides an overview and analysis of the causes and consequences of the massive and highly consequential transition in reproductive behaviour that occurred in Asia, Latin America, and Africa since the mid-20th century. In the 1950s contraceptive use was rare and women typically spend most of their reproductive years bearing and rearing children. By 2020 fertility and contraceptive use in Asia and Latin America reached levels commonly observed in the developed world. Africa’s fertility is still high, but transitions have started in all countries. This monograph is the first to provide a comprehensive analysis of these trends and their determinants, covering changes in reproductive behaviour (e.g., use of contraception and abortion), preferences (e.g., desire to limit and space births) and the role of socioeconomic development (e.g., education). The role of government policies and in particular family planning programs is discussed in depth. Particular attention is given to provide a balanced assessment of several political and scientific controversies that have beset the field. As such this book provides an interesting read for a wide audience of undergraduate and graduate students, researchers, and public health policy makers
Comparing the attitudes, norms, and beliefs of husbands and wives for reproductive, maternal, and child health—Evidence that drives effective social behavior change programming in Kebbi State
Get PDFThis brief provides rigorous evidence-based insights to implementers and researchers of social and behavior change (SBC) programs that seek to improve community knowledge, attitudes, norms and behaviors for improved health of pregnant and postpartum women. The brief focuses on key behaviors including early breastfeeding initiation within one hour of birth and exclusive breastfeeding for the first six months of life, while also uncovering the barriers and facilitators to the practice of these positive health behaviors. It is one of a series that presents findings from a Breakthrough RESEARCH study that uniquely captures data on a wide range of psychosocial drivers of behavioral outcomes in the areas of family planning, malaria, and maternal, newborn and child health, and nutrition
SNAC for enhanced oral bioavailability: An updated review
No full textThe delivery of proteins and peptides via an oral route poses numerous challenges to improve the oral bioavailability and patient compliance. To overcome these challenges, as well as to improve the permeation of proteins and peptides via intestinal mucosa, several chemicals have been studied such as surfactants, fatty acids, bile salts, pH modifiers, and chelating agents, amongst these medium chain fatty acid like C10 (sodium caprate) and Sodium N-[8-(2-hydroxybenzoyl) amino] caprylate (SNAC) and its derivatives that have been well studied from a clinical perspective. This current review enumerates the challenges involved in protein and peptide delivery via the oral route, i.e., non-invasive routes of protein and peptide administration. This review also covers the chemistry behind SNAC and toxicity as well as mechanisms to enhance the oral delivery of clinically proven molecules like simaglutide and other small molecules under clinical development, as well as other permeation enhancers for efficient delivery of proteins and peptides