1.  Title: Effectiveness of a community-based intervention to improve nutrition in young children in Senegal: a difference in difference analysis. Author: Alderman H; Ndiaye B; Linnemayr S; Ka A; Rokx C; Dieng K; Mulder-Sibanda M Source: Public Health Nutrition. 2009 May;12(5):667-73. Abstract: There are few studies of community growth promotion as a means of addressing malnutrition that are based on longitudinal analysis of large-scale programmes with adequate controls to construct a counterfactual. The current study uses a difference in difference comparison of cohorts to assess the impact on the proportion of underweight children who lived in villages receiving services provided by the Senegal Nutrition Enhancement Project between 2004 and 2006. The project, designed to extend nutrition and growth promotion intervention into rural areas through non-governmental organisation service providers, significantly lowered the risk of a child having a weight more than 2 sd below international norms. The odds ratio of being underweight for children in programme villages after introduction of the intervention was 0.83 (95% CI 0.686, 1.000), after controlling for regional trends and village and household characteristics. Most measured aspects of health care and health seeking behaviour improved in the treatment relative to the control. Language: English Keywords: SENEGAL | RESEARCH REPORT | COHORT ANALYSIS | RURAL POPULATION | CHILD NUTRITION | INTERVENTIONS | NUTRITION PROGRAMS | PROGRAM EFFECTIVENESS | BODY WEIGHT | COMMUNITY HEALTH SERVICES | PROMOTION | BEHAVIOR CHANGE | GROWTH | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Nutrition | Health | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Program Evaluation | Physiology | Biology | Marketing | Economic Factors | Behavior | Child Development Document Number: 342116 |
2.  Title: Guinea. Village health committees drive family planning uptake: communities play lead role in increased acceptability, availability. Author: Diakite O; Keita DR; Mwebesa W Source: Washington, D.C., Core Group, [2009]. 8 p. Abstract: This document highlights the Village Health Committee (VHC), a vital player in the child survival project and the integration of family planning work within Save the Children's portfolio in Guinea. The document briefly describes the committee's purpose, membership, and tasks. It focuses on a handful of the people and activities that exemplified the VHCs' unique role in ensuring that family planning was not only accessible but acceptable to the villagers they served. The document concludes with some outcomes of Save the Children's family planning component in Mandiana and Kouroussa. In effect, the VHCs' stellar success in building demand for contraception (when coupled with modest investments in existing health workers' ability to supply modern methods) resulted in a sustained increase in the use of contraception in the project zone. Language: English Keywords: GUINEA | PROGRESS REPORT | EVALUATION | COMMUNITY | RURAL POPULATION | USAID | COMMUNITY HEALTH SERVICES | DELIVERY OF HEALTH CARE | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | PERFORMANCE IMPROVEMENT | RURAL HEALTH SERVICES | FAMILY PLANNING | HEALTH SERVICES EVALUATION | PROGRAM ACCEPTABILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Residence Characteristics | Population Distribution | Geographic Factors | Population | Population Characteristics | Demographic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Primary Health Care | Health Services | Health | Program Evaluation | Programs | Organization and Administration | Management Document Number: 325193 |
| 3. Peer Reviewed Title: Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali. Author: Fournier P; Dumont A; Tourigny C; Dunkley G; Drame S Source: Bulletin of the World Health Organization. 2009 Jan;87(1):30-8. Abstract: OBJECTIVE: To evaluate the effect of a national referral system that aims to reduce maternal mortality rates through improving access to and the quality of emergency obstetric care in rural Mali (sub-Saharan Africa). METHODS: A maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services and community cost-sharing schemes was implemented in six rural health districts in Kayes region between December 2002 and November 2005. In an uncontrolled 'before and after' study, we recorded all obstetric emergencies, major obstetric interventions and maternal deaths during a 4-year observation period (1 January 2003 to 30 November 2006): the year prior to the intervention (P-1); the year of the intervention (P0), and 1 and 2 years after the intervention (P1 and P2, respectively). The primary outcome was the risk of death among obstetric emergency patients, calculated with crude case fatality rates and crude odds ratios. Analyses were adjusted for confounding variables using logistic regression. FINDINGS: The number of women receiving emergency obstetric care doubled between P-1 and P2, and the rate of major obstetric interventions (mainly Caesarean sections) performed for absolute maternal indications increased from 0.13% in P-1 to 0.46% in P2. In women treated for an obstetric emergency, the risk of death 2 years after implementing the intervention was half the risk recorded before the intervention (odds ratio, OR: 0.48; 95% confidence interval, CI: 0.30-0.76). Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from haemorrhage. CONCLUSION: The intervention showed rapid effects due to the availability of major obstetric interventions in district health centres, reduced transport time to such centres for treatment, and reduced financial barriers to care. Our results show that national programmes can be implemented in low-income countries without major external funding and that they can rapidly improve the coverage of obstetric services and significantly reduce the risk of death associated with obstetric complications. Language: English Keywords: MALI | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | COMMUNITY HEALTH SERVICES | MATERNAL MORTALITY | HEALTH SERVICES EVALUATION | TRANSPORTATION | OBSTETRICS | PREGNANCY COMPLICATIONS | COMMUNITY FINANCING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Mortality | Population Dynamics | Medicine | Diseases | Financial Activities Document Number: 341163 |
| 4. Peer Reviewed Title: Do women increase their use of reproductive health care when it becomes more available? Evidence from Indonesia. Author: Frankenberg E; Buttenheim A; Sikoki B; Suriastini W Source: Studies in Family Planning. 2009 Mar;40(1):27-38. Abstract: Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health-care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery-changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use. Language: English Keywords: INDONESIA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | COMMUNITY WORKERS | UTILIZATION OF HEALTH CARE | CHILDBIRTH | WOMEN'S HEALTH | PROGRAM ACCESSIBILITY | DECISION MAKING | COMMUNITY HEALTH SERVICES | ANTENATAL CARE | TRADITIONAL BIRTH ATTENDANTS | Developing Countries | Asia, Southeastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Health Services | Pregnancy Outcomes | Pregnancy | Reproduction | Program Evaluation | Programs | Organization and Administration | Behavior | Primary Health Care | Maternal Health Services | Maternal-Child Health Services Document Number: 341081 |
| 5. Peer Reviewed Title: Community-based promotional campaign to improve uptake of intermittent preventive antimalarial treatment in pregnancy in Burkina Faso. Author: Gies S; Coulibaly SO; Ky C; Ouattara FT; Brabin BJ; D'Alessandro U Source: American Journal of Tropical Medicine and Hygiene. 2009 Mar;80(3):460-9. Abstract: Malaria preventive strategies in pregnancy were assessed in a health center randomized trial comparing intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) with and without community based promotional activities in rural Burkina Faso. The study involved 2,240 secundigravidae and secundigravidae and evaluated factors associated with antenatal clinic (ANC) attendance and uptake of IPTp-SP. With promotion, 64.2% completed > or = 3 ANC visits compared with 44.7% without (P = 0.05). Complete uptake of IPTp-SP was 71.8% with and 49.1% without promotion (P = 0.008). The IPTp-SP uptake was lowest in adolescents delivering during high malaria transmission with (29%) or without promotion (30%). Uptake of SP was higher during the low transmission season than in the high transmission season (adjusted odds ratio = 2.17, 95% confidence interval = 1.59-3.03). Community sensitization increased ANC attendance and IPTp-SP uptake. Adolescents were the most difficult to reach, particularly during the high malaria transmission period. The impact of IPTp-SP will be limited unless this high risk group is protected. Language: English Keywords: BURKINA FASO | RESEARCH REPORT | CASE CONTROL STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | COMMUNITY | ANTIMALARIAL DRUGS | PROMOTION | CAMPAIGNS | COMMUNITY HEALTH SERVICES | ANTENATAL CARE | PREVENTIVE MEDICINE | UTILIZATION OF HEALTH CARE | AGE FACTORS | SEASONAL VARIATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Residence Characteristics | Population Distribution | Geographic Factors | Malaria | Parasitic Diseases | Diseases | Marketing | Communication Programs | Communication | Primary Health Care | Health Services | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Medicine | Population Dynamics Document Number: 331127 |
| 6. Peer Reviewed Title: Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study. Author: Javanparast S; Coveney J; Saikia U Source: BMC Health Services Research. 2009;9:36. Abstract: BACKGROUND: Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. METHODS: Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. RESULTS: The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be addressed. Turning to community stakeholders, greater emphasis has been placed on community capabilities, informal link with other social sectors based on trust and local initiatives. CONCLUSION: This research provided a picture of the differences in the perceptions and values of different stakeholders with respect to primary health care concepts. The study suggests that a top-down approach, which still exists among health policy-makers, is a key obstacle that delays, and possibly worse, undermines the implementation of the comprehensive strategy codified by the Alma-Ata Declaration. A need to revitalize primary health care to use its full potential and to combine top-down and bottom-up approaches by narrowing the gap between perceptions of policy makers and those who provide and receive health-related services is crucial. Language: English Keywords: IRAN | RESEARCH REPORT | KAP SURVEYS | COMPARATIVE STUDIES | CHILDREN | POLICYMAKERS | COMMUNITY | COMMUNITY WORKERS | HEALTH PERSONNEL | PRIMARY HEALTH CARE | CHILD NUTRITION | MALNUTRITION | PERCEPTION | HEALTH POLICY | COMMUNITY HEALTH SERVICES | Middle East | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Administrative Personnel | Organization and Administration | Residence Characteristics | Population Distribution | Geographic Factors | Delivery of Health Care | Health | Health Services | Nutrition | Nutrition Disorders | Diseases | Psychological Factors | Behavior | Policy | Political Factors | Sociocultural Factors Document Number: 331083 |
| 7. Peer Reviewed Title: Actual cost of providing long-acting reversible contraception: a study of Implanon((R)) cost. Author: Lipetz C; Phillips C; Fleming C Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):75-9. Abstract: BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) has judged Implanon((R)) to be the most cost effective of the long-acting reversible contraception (LARC) methods, and its cost effectiveness is enhanced with increased duration of use. Gwent Sexual and Reproductive Health service provides unrestricted use of Implanon, and with the number of implants fitted increasing annually the service wanted to know how long clients were keeping their contraceptive implants in and the cost of implant provision. METHODS: The actual cost of providing Implanon was calculated in a cohort of 493 patients within a community-based sexual and reproductive health service, and compared to that predicted in the NICE Clinical Guideline 30 on LARC. RESULTS: The annual cost for the method (using Implanon) was pound77.49, 25% lower than the estimate made by NICE, despite a shorter duration of use of the method. CONCLUSION: The actual cost in this community-based sexual and reproductive health service may not be transferable to other settings such as general practice. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | COST BENEFIT ANALYSIS | COHORT ANALYSIS | WOMEN | CONTRACEPTIVE IMPLANTS | COST EFFECTIVENESS | COMMUNITY HEALTH SERVICES | FAMILY PLANNING PROGRAM EVALUATION | TIME FACTORS | Developed Countries | Europe, Western | Europe | Research Methodology | Quantitative Evaluation | Evaluation | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Evaluation Indexes | Primary Health Care | Health Services | Delivery of Health Care | Health | Family Planning Programs | Population Dynamics Document Number: 330950 |
| 8. Title: Alleviating the burden of responsibility: report on a study of men as providers of community-based HIV/AIDS care and support in Lesotho. Author: Newman C; Makoae N; Reavely E; Fogarty L Source: Chapel Hill, North Carolina, IntraHealth International, Capacity Project, 2009 Jan. 101 p. Abstract: This study demonstrates a range of perspectives about gender and HIV/AIDS care from those participating in and potentially affected by health care initiatives, and makes recommendations for increasing the number of male community-based providers of HIV/AIDS care. The objectives of the study were as follows: 1. Determine the need to bring men into community-based HIV/AIDS care and Support; 2. Determine the feasibility of engaging men as providers of community-based HIV/AIDS care and support, especially the gender-related and cultural factors that need to be addressed to increase male involvement in community-based care, based on an analysis of gender relations in Lesotho; 3. Identify factors that facilitate or hinder substantive and sustained male involvement in community-based HIV/AIDS care and support; and 4. Make recommendations for feasible gender-redistributive recruitment, training, support or retention strategies to increase the number of male communitybased providers of HIV/AIDS care and support in Lesotho. Language: English Keywords: LESOTHO | EVALUATION REPORT | KAP SURVEYS | MEN | HEALTH PERSONNEL | LABOR FORCE | COMMUNITY WORKERS | HIV INFECTIONS | COMMUNITY HEALTH SERVICES | CAPACITY BUILDING | GENDER ISSUES | SEX DISCRIMINATION | NEEDS ASSESSMENT | MEN'S INVOLVEMENT | TRADITIONAL HEALTH PRACTICES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Delivery of Health Care | Health | Human Resources | Economic Factors | Viral Diseases | Diseases | Primary Health Care | Health Services | Program Sustainability | Programs | Organization and Administration | Sociocultural Factors | Social Discrimination | Social Problems | Culture Document Number: 325235 |
| 9. Peer Reviewed Title: Comparison of T-SPOT.TB assay and tuberculin skin test for the evaluation of young children at high risk for tuberculosis in a community setting. Author: Nicol MP; Davies MA; Wood K; Hatherill M; Workman L; Hawkridge A Source: Pediatrics. 2009 Jan;123(1):38-43. Abstract: OBJECTIVE: We wished to compare the sensitivity of an enzyme-linked immunospot assay (T-SPOT.TB; Oxford Immunotec, Oxford, United Kingdom) and the tuberculin skin test for the detection of tuberculosis infection in very young children being evaluated for active tuberculosis in a rural community setting. METHODS: Children with a history of exposure to tuberculosis and children presenting to a local clinic or hospital with symptoms suggesting tuberculosis were admitted to a dedicated case verification ward. T-SPOT.TB testing was performed, and children were evaluated with a clinical examination, a tuberculin skin test, chest radiographs, and cultures of induced sputum and gastric lavage specimens. The diagnosis was determined by using a clinical algorithm. RESULTS: A total of 243 children (median age: 18 months) were recruited, of whom 214 (88%) had interpretable T-SPOT.TB results. Children > or =12 months of age were more likely than younger children to have positive T-SPOT.TB results, whereas tuberculin skin test results were unaffected by age. The sensitivity of the T-SPOT.TB was no better than that of the tuberculin skin test for culture-confirmed tuberculosis (50% and 80%, respectively) and was poorer for the combined group of culture-confirmed and clinically probable tuberculosis (40% and 52%, respectively). For the 50 children clinically categorized as not having tuberculosis, the specificity of both the T-SPOT.TB and the tuberculin skin test was 84%. CONCLUSIONS: For young children presenting in a community setting after exposure to tuberculosis or with symptoms suggesting tuberculosis, T-SPOT.TB cannot be used to exclude active disease. The sensitivity of this assay may be impaired for very young children. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | COMPARATIVE STUDIES | CHILDREN | COMMUNITY | TUBERCULOSIS | TESTING | COMMUNITY HEALTH SERVICES | LABORATORY EXAMINATIONS AND DIAGNOSES | DERMATOLOGICAL EFFECTS | PHYSICAL EXAMINATIONS AND DIAGNOSES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Infections | Diseases | Measurement | Primary Health Care | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Physiology | Biology Document Number: 328039 |
| 10. Title: Side effects of oral misoprostol for the prevention of postpartum hemorrhage: results of a community-based randomised controlled trial in rural India. Author: Patted SS; Goudar SS; Naik VA; Bellad MB; Edlavitch SA; Kodkany BS; Patel A; Chakraborty H; Derman RJ; Geller SE Source: Journal of Maternal-Fetal and Neonatal Medicine. 2009 Jan;22(1):24-8. Abstract: OBJECTIVE: To investigate the side effects of 600 microg oral misoprostol given for the mother and the newborn to prevent postpartum hemorrhage (PPH). METHODS: One thousand six hundred twenty women delivering at home or subcentres in rural India were randomised to receive misoprostol or placebo in the third stage of labour. Women were evaluated for shivering, fever, nausea, vomiting and diarrhea at 2 and 24 h postpartum. Newborns were evaluated within 24 h for diarrhea, vomiting and fever. Symptoms were graded as absent, mild-to-moderate or severe. RESULTS: Women who received misoprostol had a significantly greater incidence of shivering (52%vs. 17%, p < 0.001) and fever (4.2%vs. 1.1%, p < 0.001) at 2 h postpartum compared with women who received placebo. At 24 h, women in the misoprostol group experienced significantly more shivering (4.6%vs. 1.4%, p < 0.001) and fever (1.4%vs. 0.4%, p < 0.03). There were no differences in nausea, vomiting or diarrhea between the two groups. There were no differences in the incidence of vomiting, diarrhea or fever for newborns. CONCLUSIONS: Misoprostol is associated with a significant increase in postpartum maternal shivering and fever with no side effects for the newborn. Given its proven efficacy for the prevention of PPH, the benefits of misoprostol are greater than the associated risks. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | RURAL POPULATION | COMMUNITY HEALTH SERVICES | SIDE EFFECTS | MISOPROSTOL | BLEEDING | PREVENTION AND CONTROL | PREGNANCY COMPLICATIONS | ORAL CONTRACEPTIVES, SIDE EFFECTS | SIGNS AND SYMPTOMS | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Puerperium | Reproduction | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Primary Health Care | Health Services | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Diseases | Contraceptive Safety | Safety | Public Health Document Number: 330717 |
| 11. Peer Reviewed Title: The UALE Project: decline in the incidence of HIV and sexually transmitted infections and increase in the use of condoms among sex workers in Guatemala. Author: Sabido M; Giardina F; Hernandez G; Fernandez VH; Monzon JE; Ortiz R; Montoliu A; Casabona J Author: UALE team Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51 Suppl 1:S35-41. Abstract: OBJECTIVES: To assess the impact of a multilevel sexually transmitted infections (STI)/HIV prevention and treatment intervention on the incidence of STIs and HIV, the use of condoms, and HIV knowledge among sex workers (SWs). METHODS: An open-enrolment cohort of 1554 SWs attending STI clinics integrated within the primary health care system of Escuintla, Guatemala. They were offered 6 monthly STI/HIV screening, condom promotion, education, and community-based interventions. We evaluated trends in condom use, HIV-related knowledge, and STI/HIV incidence using generalized estimating equations. RESULTS: For over three and a half years, there was a significant increase in the proportion of consistent condom use from the baseline visit through the third follow-up visit (94.29%-99.11% with new clients and 90.36%-97.22% with regular clients) and in HIV-related knowledge (95.99%-97.22%). Except for syphilis, we observed a significant decline in gonorrhoea, chlamydia, trichomoniasis, and candidiasis in each follow-up visit, from 11.30 per 100 person-years, 10.71 per 100 person-years, 6.88 per 100 person-years, and 8.23 per 100 person-years in the first follow-up visit to 6.44 per 100 person-years, 6.21 per 100 person-years, 4.81 per 100 person-years, and 6.17 per 100 person-years in the third follow-up visit, for each STI, respectively. HIV global incidence was 0.41 per 100 person-years, and it significantly declined from 1.85 per 100 person-years (2005) to 0.42 per 100 person-years (2008). CONCLUSIONS: Although a longer follow-up would be needed, the results suggest that the intervention was feasible and has been shown to be effective in reducing STI and HIV incidence and in increasing condom use with clients and HIV-related knowledge. Language: English Keywords: GUATEMALA | RESEARCH REPORT | KAP SURVEYS | COHORT ANALYSIS | CLINICAL RESEARCH | LONGITUDINAL STUDIES | SEX WORKERS | WOMEN IN DEVELOPMENT | HIV PREVENTION | CONDOM USE | SEXUALLY TRANSMITTED DISEASE PREVENTION | SCREENING | SEX EDUCATION | COMMUNITY HEALTH SERVICES | PREVALENCE | Central America | Latin America | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Sex Behavior | Behavior | Economic Development | Economic Factors | HIV Infections | Viral Diseases | Diseases | Risk Reduction Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Education | Primary Health Care | Measurement Document Number: 341106 |
| 12. Title: Child health services in Kenya. January 2009. Based on further analysis of the 2004 Kenya Service Provision Assessment Survey. Author: Wamae A; Kichamu G; Kundu F; Muhunzu I Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. [38] p. (USAID Contract No. GPO-C-00-03-00002-00Kenya Working Papers No. 2) Abstract: Given the worrying trends in infant and child mortality rates, there is a clear need to assess current practices in the management of childhood illnesses and to identify opportunities for intervention. The 2004 Kenya Service Provision Assessment Survey (KSPA) findings indicate that most health care providers are not taking care of sick children holistically, but rather are treating children only for the presenting illness. Using data obtained from the 2004 KSPA, this study aims to establish the factors that are associated with the promotion of child health using a holistic approach, such as the Integrated Management of Childhood Illness (IMCI) strategy to manage a sick child. The IMCI strategy aims to reduce morbidity and infant and child mortality by implementing three main components: improving health workers' skills in case management; improving the health systems; and improving family and community childcare practices. Three composite dependent variables representing the holistic approach to child health care were created to measure the following: full assessment of sick child; proper counseling of the child's caretaker; and facility support services for holistic care of sick children. The independent variables used in the analysis include facility type, facility managing authority, region, qualifications of the provider, and sex of the provider. Almost all health providers surveyed missed critical opportunities to conduct a full assessment of the sick children who presented to them for care. According to the survey, enrolled nurses and doctors were doing better in full assessment and counseling of sick children compared to registered nurses and clinical officers. This difference can be attributed to the fact that doctors and enrolled nurses were likely to have received IMCI training in the previous year compared to registered nurses. Notably, about twice as many female health providers as male health providers assessed major signs and thrice as many female health workers assessed for all three danger signs. Female providers were also more likely than male providers to properly monitor child growth. Counseling caretakers on children's illnesses was generally poor, with only one in every five caretakers being counseled in clinics and one in every ten caretakers being counseled in health centres. Male providers were more likely to counsel caretakers than their female counterparts. Providers in private facilities were twice as likely to counsel caretakers as providers in public facilities. The full range of essential equipment was lacking in almost all facilities. Hospitals were more likely to be stocked with all essential equipment, followed by dispensaries and maternities with health centers and clinics the least likely. The results reveal that the quality of care provided to sick children at the first level of health facilities should be improved. Also, help is needed to determine the areas that should be emphasized during the training and supervision of IMCI and other child survival strategies. The KSPA results also suggest the need to improve the skills of more health workers managing children younger than five years and to mobilize more resources for child health. Language: English Keywords: KENYA | RESEARCH REPORT | HEALTH SURVEYS | CHILDREN | HEALTH PERSONNEL | CHILD HEALTH SERVICES | HEALTH SERVICES EVALUATION | QUALITY OF HEALTH CARE | INTEGRATED PROGRAMS | HEALTH SERVICES ADMINISTRATION | COMMUNITY HEALTH SERVICES | COUNSELING | SEX FACTORS | EXAMINATIONS AND DIAGNOSES | PRIVATE SECTOR | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Maternal-Child Health Services | Primary Health Care | Health Services | Program Evaluation | Programs | Organization and Administration | Management | Clinic Activities | Program Activities | Medical Procedures | Medicine | Macroeconomic Factors | Economic Factors Document Number: 329887 |
| 13. Peer Reviewed Title: A new way of perceiving the pandemic: the findings from a participatory research process on young Africans' stories about HIV/AIDS. Author: Winskell K; Enger D Source: Culture, Health and Sexuality. 2009 May;11(4):453-467. Abstract: This paper presents the findings, shares the methodology and outlines the benefits of a multi-country participatory research process on a unique data source: stories about HIV and AIDS written by young Africans. Between 1997 and 2005, more than 105,000 young people from 37 countries participated in competitions inviting them to think up storylines for short fiction films to educate their communities about HIV and AIDS as part of the 'Scenarios from Africa' communication process. The winning stories were selected by juries made up of: PLWH and other local specialists in prevention, treatment and care; former contest winners and other young people; and communication specialists, including the top African directors, who went on to transform the ideas into short films. In 2005, over 200 jurors selected 30 winners from the 22,894 stories submitted that year by 63,327 contest participants. After reading around 200 stories each and participating in the selection process, jurors compiled their observations and recommendations. The jurors' findings reveal notable persistent shortcomings in existing communication efforts and identify key emerging needs. In some areas, they show remarkable consistency across the continent. Jurors view this as a powerful needs assessment, networking and capacity building process that motivates action. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | METHODOLOGICAL STUDIES | CROSS-CULTURAL COMPARISONS | ACTION RESEARCH | ADOLESCENTS | PERSONS LIVING WITH HIV/AIDS | PERCEPTION | HIV INFECTIONS | EPIDEMICS | FILM AND VIDEO | DRAMA AND THEATER | HEALTH EDUCATION | COMMUNITY HEALTH SERVICES | CONTESTS | Africa | Developing Countries | Studies | Research Methodology | Comparative Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Psychological Factors | Behavior | Mass Media | Communication | Culture | Sociocultural Factors | Education | Primary Health Care | Health Services | Delivery of Health Care | Health | Incentives | Policy | Political Factors Document Number: 341091 |
| 14. Peer Reviewed Title: Wellness programmes for persons living with HIV/AIDS: experiences from Eastern Cape province, South Africa. Author: Worley S; Didiza Z; Nomatshila S; Porter S; Makwedini N; Macharia D; Hoos D Source: Global Public Health. 2009 Apr 3;:1-18. Abstract: Columbia University's International Centre for AIDS Care and Treatment Programmes (ICAP) supports the establishment of HIV prevention, care and treatment programmes, in resource-limited countries, through the President's Emergency Plan for AIDS Relief. In South Africa (SA), ICAP has collaborated with the Eastern Cape Department of Health since 2004, to support HIV treatment and care programmes at public healthcare facilities in rural and urban areas. Adherence, psychosocial and other supportive services have been combined into Wellness Programmes that have been situated within hospital-based Wellness Centres in two rural regions, and integrated within primary healthcare facilities in a third. This paper reviews components of wellness services for people living with HIV/AIDS including: voluntary counselling and testing, disclosure and prevention, ongoing counselling, health literacy and peer education, community- and home-based care, adherence support, and associated comprehensive care continuums. It also describes local context in which the Wellness Programmes were established. Finally it describes processes, successes and challenges, with programme development, and useful indicators monitored, lessons learned and strategies to strengthen and expand such programmes. Insights provided may inform other efforts to create sustainable systems of interdisciplinary care and accessible psychosocial support for HIV-infected persons within public facilities in resource-constrained settings. Language: English Keywords: SOUTH AFRICA | PROGRESS REPORT | EVALUATION | PERSONS LIVING WITH HIV/AIDS | RURAL POPULATION | PEER EDUCATORS | USER COMPLIANCE | AIDS PREVENTION | PSYCHOSOCIAL FACTORS | HOSPITALS | HOME CARE | COMMUNITY HEALTH SERVICES | VOLUNTARY COUNSELING AND TESTING | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Education | Behavior | AIDS | Health Facilities | Delivery of Health Care | Health | Care and Support | Health Services | Primary Health Care | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Programs | Organization and Administration Document Number: 341475 |
| 15. Title: The expansion of community-based tuberculosis programming: crucial program design issues for new partners. Author: CORE Group Source: Washington, D.C., CORE Group, 2008 Jan. 49 p. (USAID Cooperative Agreement No. GHS-A-00-05-0006-00) Abstract: The Tuberculosis Working Group of the CORE Group met with global partners and colleague agencies over two days in Washington, D.C., in early 2007. The meeting, "Lessons Learned Exchange: TB Programming from the Community-Based Perspective," sought to gather and exchange lessons learned in community-based treatment of tuberculosis (TB). This paper reflects participant discussions and lessons learned that were articulated throughout the event. This document outlines nine project-design challenges most likely to face those working at the community level. This document should be used as a primer for gaining a better understanding of the challenges community-based programs and providers face, as well as some of the ways nongovernmental organizations (NGOs) are currently addressing these challenges. This document is not intended to outline a comprehensive community-based TB effort. There is no right way to respond to the challenges outlined here. The best way to answer them will depend on the nature of your organization and in the setting in which you seek to do this work. (author's) Language: English Keywords: DEVELOPING COUNTRIES | TEACHING MATERIALS | NONGOVERNMENTAL ORGANIZATIONS | PROVIDERS WITH CLIENTS | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | COMMUNITY HEALTH SERVICES | PROGRAM DESIGN | INTEGRATED PROGRAMS | STIGMA | BEHAVIOR CHANGE COMMUNICATION | UNIVERSAL PRECAUTIONS | Organizations | Political Factors | Sociocultural Factors | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Infections | Primary Health Care | Programs | Organization and Administration | Social Problems | Behavior Change | Behavior | Communication Programs | Communication | Safety | Public Health Document Number: 324508 |
| 16. Title: Family planning counseling in community home-based care programs. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, [2008]. [2] p. (Research Briefs on Family Planning Service Delivery) Abstract: The clients of community home-based health care (CHBC) programs have more complex reproductive health needs than previously thought, according to the results of a recent USAID-supported study in Kenya. Working with Pathfinder International, scientists from Family Health International sought to understand the contraceptive and reproductive health needs of clients and caregivers associated with the Community-Based HIV / AIDS Care, Support, and Prevention (COPHIA) project. The scientists interviewed 171 clients and 183 caregivers (as well as 86 providers) of CBHC regarding their sexual behavior, contraceptive practices, and pregnancy experiences. The results offer insight into the need for comprehensive reproductive health services among CHBC clients, whose family planning issues are often overlooked. The need has special urgency, because community stigma can make the consequences of pregnancy -- intended or unintended -- more dire for CHBC clients than for other women. The study uncovered fiercely negative attitudes not only among community members generally but also among caregivers toward women with HIV who want to have children. Many caregivers resist requests by their clients for advice on how to conceive and deliver babies without infection. (Excerpts) Language: English Keywords: KENYA | SUMMARY REPORT | PROVIDERS WITH CLIENTS | PERSONS LIVING WITH HIV/AIDS | COMMUNITY HEALTH SERVICES | HOME CARE | REPRODUCTIVE HEALTH | NEEDS | FERTILITY PREFERENCES | SEX BEHAVIOR | STIGMA | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Primary Health Care | Care and Support | Economic Factors | Fertility | Population Dynamics | Demographic Factors | Population | Behavior | Social Problems | Sociocultural Factors Document Number: 331698 |
| 17. Title: Reaching out to youth: Youth-friendly sexual and reproductive health services through schools, clinics, and communities. Author: Project HOPE Source: Millwood, Virginia, Project HOPE, 2008. 8 p. Abstract: Uzbekistan’s largely conservative social norms mean that matters of sexuality and reproduction are not openly discussed and certainly not with young, unmarried people. Yet, youth need straightforward answers and an atmosphere that encourages them to ask questions. The Government of Uzbekistan recognized this need and decreed that the subject be taught in secondary schools. This act alone was insufficient: not only was the decree or prikaz unaccompanied by funding for teacher training and educational materials but the decree in and of itself did not create an environment for teachers, students, parents, or health. By integrating family planning into it's child survival project (2003-2007), Project HOPE created two new youth-friendly clinics and three youth-friendly rooms within clinics in five pilot sub districts in the Navoi oblast with plans to expand these services to other districts in Uzbekistan. This case study highlights the success achieved in increasing access for 31,673 young adults to youth friendly services. (excerpt) Language: English Keywords: UZBEKISTAN | PROGRESS REPORT | EVALUATION | ADOLESCENTS | COMMUNITY | USAID | SEXUALLY TRANSMITTED DISEASE PREVENTION | REPRODUCTIVE HEALTH | SCHOOL-BASED SERVICES | COMMUNITY HEALTH SERVICES | CLINICS | INTEGRATED PROGRAMS | SEX EDUCATION | CHILD SURVIVAL | TRAINING PROGRAMS | Developing Countries | Asia, Central | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Health | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health Facilities | Education | Survivorship | Length of Life | Mortality | Population Dynamics Document Number: 328456 |
| 18. Title: Community-based HIV interventions for young people. Author: UNAIDS. Inter-Agency Task Team on HIV and Young People Source: New York, New York, United Nations Population Fund, HIV/AIDS Branch, [2008]. 8 p. (Guidance Brief) Abstract: This Brief has been developed by the Inter-Agency Task Team (IATT) on HIV and Young People1 to assist United Nations Country Teams (UNCT) and UN Theme Groups on HIV/AIDS in providing guidance to their staffs, governments, development partners, civil society and other implementing partners on community HIV interventions for young people. It is part of a series of seven global Guidance Briefs that focus on HIV prevention, treatment, care and support interventions for young people that can be delivered through different settings and for a range of target groups. Language: English Keywords: DEVELOPING COUNTRIES | RECOMMENDATIONS | EVALUATION | YOUTH | POLICYMAKERS | COMMUNITY | COMMUNITY HEALTH SERVICES | HIV PREVENTION | COMMUNITY PARTICIPATION | GOVERNMENT PROGRAMS | UNAIDS | MONITORING | PROGRAM EVALUATION | INTERNET | INFORMATION SOURCES | Age Factors | Population Characteristics | Demographic Factors | Population | Administrative Personnel | Organization and Administration | Residence Characteristics | Population Distribution | Geographic Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Programs | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Information Networks | Communication | Information Document Number: 329554 |
| 19. Title: School-centred HIV and AIDS care and support in Southern Africa: technical consultation report, 22-24 May 2007, Gaborone, Botswana. Author: UNESCO Source: Paris, France, UNESCO, Education Sector, Division for the Coordination of UN Priorities in Education, Section on HIV and AIDS, 2008. 39 p. Abstract: There are currently more people living with HIV in Southern Africa than in any other region in the world. As a result of the AIDS epidemic, schools urgently need to respond to the changing needs of their teachers, students and local communities, not only to protect the basic functioning of the education system, but also as part of the wider responsibility to respond to HIV and AIDS in the region. While some may argue that an educational institution's response to HIV and AIDS should be limited to education about HIV prevention, schools and other institutions can - and do - play a significant role in supporting all the dimensions of a comprehensive response to HIV and AIDS: including prevention, treatment, care and support. Schools in Southern Africa urgently need to respond to the HIV-related needs of their students, teachers and communities - as part of efforts to achieve universal access to HIV prevention programmes, treatment and care, but also as a necessary part of achieving international targets including Education for All (EFA) and the Millennium Development Goals (MDGs). (excerpt) Language: English Keywords: AFRICA, SOUTHERN | PROGRESS REPORT | EVALUATION | SCHOOL AGE POPULATION | SCHOOL-BASED SERVICES | TECHNICAL ASSISTANCE | HIV INFECTIONS | AIDS PREVENTION | COMMUNITY HEALTH SERVICES | INTEGRATED PROGRAMS | ANTIRETROVIRAL THERAPY | COMMUNITY PARTICIPATION | PROGRAM SUSTAINABILITY | Africa, Sub Saharan | Africa | Developing Countries | Population Characteristics | Demographic Factors | Population | Programs | Organization and Administration | Viral Diseases | Diseases | AIDS | Primary Health Care | Health Services | Delivery of Health Care | Health | HIV Document Number: 325694 |
| 20. Title: The state of Africa's children 2008. Child survival. Author: UNICEF Source: New York, New York, UNICEF, 2008 May. 54 p. Abstract: Every year, the United Nations Children's Fund (UNICEF) publishes The State of the World's Children, the most comprehensive and authoritative report on the world's youngest citizens. The State of the World's Children 2008, published in January 2008, examines the global realities of maternal and child survival and the prospects for meeting the health-related Millennium Development Goals (MDGs) - the targets set by the world community in 2000 for eradicating poverty, reducing child and maternal mortality, combating disease, ensuring environmental sustainability and providing access to affordable medicines in developing countries. This year, UNICEF is also publishing the inaugural edition of The State of Africa's Children. This volume and other forthcoming regional editions complement The State of the World's Children 2008, sharpening from a worldwide to a regional perspective the global report's focus on trends in child survival and health, and outlining possible solutions - by means of programmes, policies and partnerships - to accelerate progress in meeting the Millennium Development Goals. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | AFRICA, NORTH | TECHNICAL REPORT | CHILD HEALTH | CHILD MORTALITY | CHILD SURVIVAL | CAUSES OF DEATH | PRIMARY HEALTH CARE | CHILD HEALTH SERVICES | COMMUNITY HEALTH SERVICES | COMMUNITY PARTICIPATION | HEALTH POLICY | HEALTH SERVICES ADMINISTRATION | UNICEF | Developing Countries | Africa | Health | Mortality | Population Dynamics | Demographic Factors | Population | Survivorship | Length of Life | Health Services | Delivery of Health Care | Maternal-Child Health Services | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Management | UN | International Agencies | Organizations Document Number: 327008 |
| 21. Title: FP during the first year postpartum. Author: United States. Agency for International Development [USAID]. Community Based Family Planning Source: [Washington, D.C.], USAID, 2008 Jan. [4] p. (Community Based Family Planning Technical Update No. 5) Abstract: Research has demonstrated that over 90% of women during their first year postpartum either want to delay the next pregnancy for at least two years or avoid future pregnancies all together. There is also strong evidence of the health risk for the mother and the baby related to short birth intervals. And yet, approximately one fourth of births in many developing countries occur with birth-to-birth intervals less than 24 months. For community-based programs, the need to integrate postpartum family planning (PPFP) information and services into other maternal, newborn, and child health services is compelling. A recent review of Demographic and Health Surveys indicated that 50% of all births occur outside of health instititutions and of those 70% receive no postpartum care. As a result, these women have limited opportunities to receive family planning information or services. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | PROGRESS REPORT | POSTPARTUM WOMEN | POSTPARTUM PROGRAMS | FAMILY PLANNING PROGRAMS | COMMUNITY HEALTH SERVICES | CHILD HEALTH SERVICES | MATERNAL HEALTH SERVICES | INTEGRATED PROGRAMS | Puerperium | Reproduction | Family Planning | Primary Health Care | Health Services | Delivery of Health Care | Health | Maternal-Child Health Services | Programs | Organization and Administration Document Number: 323749 |
| 22. Title: Introducing the IMCI community component into the curriculum ofthe Faculty of Medicine, University of Gezira. Author: Abdelrahman SH; Alfadil SM Source: Eastern Mediterranean Health Journal. 2008 May-Jun;14(3):731-741. Abstract: In 2001 the Faculty of Medicine of the University of Gezira (FMUG) started to introduce the Integrated Management of Childhood Illness (IMCI) strategy into its medical curriculum. The emphasis was on pre-service training that addresses standard case management and the IMCI community component. This report presents the experience of FMUG in integrating such a training package into the medical curriculum. It explains the rationale for introducing the IMCI community component and the guiding principles for doing so. It describes the community-based courses into which the community component was integrated, the implementation and impact of the programme and the constraints faced. (author's) Language: English Keywords: SUDAN | RESEARCH REPORT | MEDICAL STUDENTS | SCHOOLS, MEDICAL | CURRICULUM | TRAINING PROGRAMS | CHILD HEALTH | MANAGEMENT | STANDARDS | COMMUNITY HEALTH SERVICES | PERFORMANCE IMPROVEMENT | Developing Countries | Africa, North | Africa | Students | Education | Schools | Health | Organization and Administration | Research Methodology | Primary Health Care | Health Services | Delivery of Health Care Document Number: 327177 |
| 23. Title: Provider perceptions of reproductive health service quality in Jordanian public community health centers. Author: Al-Qutob R; Nasir LS Source: Health Care for Women International. 2008 May;29(5):539-550. Abstract: Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform. (author's) Language: English Keywords: JORDAN | RESEARCH REPORT | FOCUS GROUPS | HEALTH PERSONNEL | REPRODUCTIVE HEALTH | COMMUNITY HEALTH SERVICES | QUALITY OF HEALTH CARE | DELIVERY OF HEALTH CARE | PERCEPTION | PUBLIC SECTOR | Developing Countries | Middle East | Data Collection | Research Methodology | Health | Primary Health Care | Health Services | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Psychological Factors | Behavior | Macroeconomic Factors | Economic Factors Document Number: 326446 |
| 24. Title: Linking sexual and reproductive health and HIV/AIDS. Gateways to integration: A case study from Kenya. Antiretroviral delivery within a sexual and reproductive health setting: transition from traditional to pioneering role. Author: Armstrong S Source: Geneva, Switzerland, World Health Organization, 2008. 24 p. Also available in Spanish: http://149.120.32.2/upload/lib_pub_file/795_filename_ippf_linkages_kenya_sp.pdf and French: http://149.120.32.2/upload/lib_pub_file/832_filename_linkages_kenya_fr1.pdf Abstract: The process of linking sexual and reproductive health and HIV/AIDS needs to work in both directions: traditional sexual and reproductive health services need to integrate HIV/AIDS interventions, and programmes set up to address the AIDS epidemic need to integrate more general services for sexual and reproductive health. The case studies featured in this series have been chosen to demonstrate this two-way flow and to reflect the diversity of integration models. While these case studies focus primarily on service delivery components, structures, systems and policy issues are also important elements of successful integration. Language: English Keywords: KENYA | RESEARCH REPORT | CASE STUDIES | COMMUNITY | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | REPRODUCTIVE HEALTH | VOLUNTARY COUNSELING AND TESTING | INTEGRATED PROGRAMS | COMMUNITY HEALTH SERVICES | PROGRAM SUSTAINABILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Residence Characteristics | Population Distribution | Geographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | AIDS | Health | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Programs | Organization and Administration | Primary Health Care Document Number: 327835 |
| 25. Peer Reviewed Title: Uptake of HIV testing and outcomes within a Community-based Therapeutic Care (CTC) programme to treat severe acute malnutrition in Malawi: a descriptive study. Author: Bahwere P; Piwoz E; Joshua MC; Sadler K; Grobler-Tanner CH; Guerrero S; Collins S Source: BMC Infectious Diseases. 2008;8:106. Abstract: BACKGROUND: In Malawi and other high HIV prevalence countries, studies suggest that more than 30% of all severely malnourished children admitted to inpatient nutrition rehabilitation units are HIV-infected. However, clinical algorithms designed to diagnose paediatric HIV are neither sensitive nor specific in severely malnourished children. The present study was conducted to assess : i) whether HIV testing can be integrated into Community-based Therapeutic Care (CTC); ii) to determine if CTC can improve the identification of HIV infected children; and iii) to assess the impact of CTC programmes on the rehabilitation of HIV-infected children with Severe Acute Malnutrition (SAM). METHODS: This community-based cohort study was conducted in Dowa District, Central Malawi, a rural area 50 km from the capital, Lilongwe. Caregivers and children admitted in the Dowa CTC programme were prospectively (Prospective Cohort = PC) and retrospectively (Retrospective Cohort = RC) admitted into the study and offered HIV testing and counseling. Basic medical care and community nutrition rehabilitation was provided for children with SAM. The outcomes of interest were uptake of HIV testing, and recovery, relapse, and growth rates of HIV-positive and uninfected children in the CTC programme. Student's t-test and analysis of variance were used to compare means and Kruskall Wallis tests were used to compare medians. Dichotomous variables were compared using Chi2 analyses and Fisher's exact test. Stepwise logistic regression with backward elimination was used to identify predictors of HIV infection (alpha = 0.05). RESULTS: 1273 and 735 children were enrolled in the RC and PC. For the RC, the average age (SD) at CTC admission was 30.0 (17.2) months. For the PC, the average age at admission was 26.5 (13.7) months. Overall uptake of HIV testing was 60.7% for parents and 94% for children. HIV prevalence in severely malnourished children was 3%, much lower than anticipated. 59% of HIV-positive and 83% of HIV-negative children achieved discharge Weight-For-Height (WFH) > or = 80% of the NCHS reference median (p = 0.003). Clinical algorithms for diagnosing HIV in SAM children had poor sensitivity and specificity. CONCLUSION: CTC is a potentially valuable entry point for providing HIV testing and care in the community to HIV infected children with SAM. Language: English Keywords: MALAWI | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | STATISTICAL REGRESSION | COMMUNITY | PERSONS LIVING WITH HIV/AIDS | CHILDREN | PREVALENCE | COMMUNITY HEALTH SERVICES | MALNUTRITION | HIV TESTING | NUTRITION PROGRAMS | COMPLICATIONS | INTEGRATED PROGRAMS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Residence Characteristics | Population Distribution | Geographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Measurement | Primary Health Care | Health Services | Delivery of Health Care | Health | Nutrition Disorders | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Programs | Organization and Administration Document Number: 328610 |
| 26. Peer Reviewed Title: NGO facilitation of a government community-based maternal and neonatal health programme in rural India: Improvements in equity. Author: Baqui AH; Rosecrans AM; Williams EK; Agrawal PK; Ahmed S Source: Health Policy and Planning. 2008;23(4):234-243. Abstract: Socio-economic disparities in health have been well documented around the world. This study examines whether NGO facilitation of the government's community-based health programme improved the equity of maternal and newborn health in rural Uttar Pradesh, India. A quasi-experimental study design included one intervention district and one comparison district of rural Uttar Pradesh. A household survey conducted between January and June 2003 established baseline rates of programme coverage, maternal and newborn care practices, and health care utilization during 2001-02. An endline household survey was conducted after 30 months of programme implementation between January and March 2006 to measure the same indicators during 2004-05. The changes in the indicators from baseline to endline in the intervention and comparison districts were calculated by socio-economic quintiles, and concentration indices were constructed to measure the equity of programme indicators. The equity of programme coverage and antenatal and newborn care practices improved from baseline to endline in the intervention district while showing little change in the comparison district. Equity in health care utilization for mothers and newborns also showed some improvements in the intervention district, but notable socio-economic differentials remained, with the poor demonstrating less ability to access health services. NGO facilitation of government programmes is a feasible strategy to improve equity of maternal and neonatal health programmes. Improvements in equity were most pronounced for household practices, and inequities were still apparent in health care utilization. Furthermore, overall programme coverage remained low, limiting the ability to address equity. Programmes need to identify and address barriers to universal coverage and care utilization, particularly in the poorest segments of the population. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | PROGRAM SUSTAINABILITY | MATERNAL-CHILD HEALTH SERVICES | COMMUNITY HEALTH SERVICES | GOVERNMENT PROGRAMS | INTERVENTIONS | PROGRAM EFFECTIVENESS | UTILIZATION OF HEALTH CARE | PROGRAM ACCESSIBILITY | NONGOVERNMENTAL ORGANIZATIONS | Developing Countries | Asia, Southern | Asia | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Organizations | Political Factors | Sociocultural Factors Document Number: 327081 |
| 27. Peer Reviewed Title: HIV / AIDS and hope(lessness). Author: Barnett T Source: Global Public Health. 2008 Jul;3(3):233-248. Abstract: Public policy debates, about HIV and prevention policy, have tended to occupy positions at the extremes of the two camps of rational choice, theorists and structuralists. This paper argues that the concept of hope may offer a way through this policy and paradigmatic log-jam. Hope is an individually measurable concept, which serves to link the ecological concept of risk environment with that of individual choice. It may be extended into broader understandings of the social epidemiology of infectious diseases. Use of an operationalised concept of hope also offers a possible way forward for rapid community diagnosis and participation in policy development, because it is immediately and intuitively accessible at three often separated levels: the individual actor, the researcher and those acting in the policy arena. (author's) Language: English Keywords: THEORETICAL STUDIES | EVALUATION | POLICYMAKERS | HIV PREVENTION | HEALTH POLICY | ATTITUDES | ABSTINENCE, BE FAITHFUL, CONDOM USE | ECOLOGY | RISK ASSESSMENT | EPIDEMIOLOGY | SOCIOLOGY | COMMUNITY HEALTH SERVICES | HIV TESTING | COMMUNITY PARTICIPATION | Administrative Personnel | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Policy | Political Factors | Sociocultural Factors | Psychological Factors | Behavior | Sex Behavior | Environment | Public Health | Health | Social Sciences | Science | Primary Health Care | Health Services | Delivery of Health Care | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine Document Number: 327756 |
| 28. Peer Reviewed Title: Use of insecticide treated nets by pregnant women and associated factors in a pre-dominantly rural population in northern Ethiopia. Author: Belay M; Deressa W Source: Tropical Medicine and International Health. 2008 Oct;13(10):1303-13. Abstract: OBJECTIVE: To describe the use of insecticide treated nets (ITNs) among pregnant women and examine factors associated with its access and use. METHODS: Community-based cross-sectional study of 815 pregnant women in eight malarious kebeles in northern Ethiopia based on two-stage cluster design from May to June 2006. Knowledge on malaria, its cause and preventive measures; treatment seeking behaviour; possession and use of ITNs by pregnant women and under-five children were ascertained through interview and observation. Logistic regression was used to determine factors associated with ITNs use. RESULTS: Knowledge about the cause, transmission and preventive measures of malaria was relatively good; 90.2% of women associated malaria with mosquito bites and 94.2% with living near water ponds. Ten per cent reported malaria illness within the 14 days before the survey, and sought treatment mainly from public health facilities (56.5%) and community health workers (37.6%). Of 815 households surveyed, 59% owned at least one non-long lasting or long-lasting ITN (59.5% rural vs. 54.5% urban; P = 0.401). Lack of access to ITNs (68.3%) and the perception that nets could not prevent malaria (27%) were the main reasons for non-ownership of nets. A total of 58.4% of 481 pregnant women from households owning at least one ITN had slept under it during the previous night. Fewer rural (56.7%) than urban women (76.2%) used ITNs (P = 0.001). In 57.6% of households with at least one ITN, under-five children had used it the night before. Higher educational attainment was an important predictor of ITNs use (OR = 3.1, 95% CI = 2.1, 4.6). CONCLUSIONS: Household ownership of ITNs and their use by pregnant women is promising with the current efforts to scale-up ITNs implementation, but the gap between ownership and use remains high. Consistent and proper use of nets by pregnant women should be ensured through information campaigns. Rapid expansion of access to long lasting ITNs requires that government and NGOs supply them in adequate numbers. Language: English Keywords: ETHIOPIA | |