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. Peer Reviewed Title: Increasing the acceptability of HIV counseling and testing with three C's: convenience, confidentiality and credibility. Author: Angotti N; Bula A; Gaydosh L; Kimchi EZ; Thornton RL; Yeatman SE Source: Social Science and Medicine. 2009 Jun;68(12):2263-70. Abstract: Agencies engaged in humanitarian efforts to prevent the further spread of HIV have emphasized the importance of voluntary counseling and testing (VCT), and most high-prevalence countries now have facilities that offer testing free of charge. The utilization of these services is disappointingly low, however, despite high numbers reporting that they would like to be tested. Explanations of this discrepancy typically rely on responses to hypothetical questions posed in terms of psychological or social barriers; often, the explanation is that people fear learning that they are infected with a disease that they understand to be fatal and stigmatizing. Yet when we offered door-to-door rapid blood testing for HIV as part of a longitudinal study in rural Malawi, the overwhelming majority agreed to be tested and to receive their results immediately. Thus, in this paper, we ask: why are more people not getting tested? Using an explanatory research design, we find that rural Malawians are responsive to door-to-door HIV testing for the following reasons: it is convenient, confidential, and the rapid blood test is credible. Our study suggests that attention to these factors in VCT strategies may mitigate the fear of HIV testing, and ultimately increase uptake in rural African settings. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | PREVALENCE | LONGITUDINAL STUDIES | RURAL POPULATION | HIV TESTING | VOLUNTARY COUNSELING AND TESTING | FEAR | Africa | Developing Countries | Measurement | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Emotions | Psychological Factors | Behavior Document Number: 342741 |
| 3. Peer Reviewed Title: [Sexual behavior and emergency contraception among adolescents from public schools in Pernambuco State, Brazil] Comportamento sexual e contracepcao de emergencia entre adolescentes de escolas Author: Araujo MS; Costa LO Source: Cadernos de Saude Publica. 2009 Mar;25(3):551-62. Abstract: This study examined knowledge and use of emergency contraception among 4,210 adolescents (14-19 years) enrolled in public schools in Pernambuco State, Brazil. The authors collected information with the Global School-Based Student Health Survey, previously validated. Knowledge, frequency, and form of use of emergency contraception were investigated. Independent variables were classified as sociodemographic and those related to sexual behavior. Most adolescents reported knowing and having received information about the method, but among those who had already used it, only 22.1% had done so correctly. Adjusted regression analysis showed greater likelihood of knowledge about the method among girls and the sexually initiated, while rural residents were 68% less knowledgeable. Rural residents showed 1.68 times higher odds of incorrect use, while girls showed 71% lower likelihood of incorrect use. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | SURVEYS | RURAL POPULATION | ADOLESCENTS | KNOWLEDGE | EMERGENCY CONTRACEPTION | CONTRACEPTIVE USAGE | SEX EDUCATION | NEEDS ASSESSMENT | South America, Eastern | South America | Latin America | Americas | Developing Countries | Sampling Studies | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Sociocultural Factors | Contraception | Family Planning | Education | Evaluation Document Number: 330737 |
| 4. Title: Adherence and treatment response among HIV-1 infected adults receiving antiretroviral therapy in a rural government hospital in southwestern Uganda. Author: Bajunirwe F; Arts EJ; Tisch DJ; King CH; Debanne SM Source: Journal of the International Association of Physicians in AIDS Care. 2009 Mar-Apr;8(2):139-147. Abstract: Background. Large-scale, government-based antiretroviral therapy (ART) programs in rural areas of resource-poor countries remain largely unevaluated. Methods. We conducted a retrospective review of all patients receiving (n = 399) to assess survival and retention in care and a prospective evaluation of patients on ART for at least 6 months (n = 175). We used 3-day self-report to measure adherence. Results. The probability (95% confidence interval [CI]) of surviving and remaining in care was 0.76 (0.72, 0.81) at 1 year. Men and patients with advanced disease were more likely to die or be lost to follow-up. At baseline, 149 (85%) reported 100% adherence. Nonadherence was associated with lack of suppression of viral replication (odds ratio [OR] = 4.5; 95% CI: 1.8, 11.5). Missing a scheduled clinic visit and lack of disclosure of HIV status were associated with nonadherence. Conclusion. Viral suppression was high, but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes. Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | ADULTS | RURAL POPULATION | HIV INFECTIONS | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | GOVERNMENT PROGRAMS | SEX FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | HIV | Programs | Organization and Administration Document Number: 331336 |
| 5. Peer Reviewed Title: Lack of a decline in HIV incidence in a rural community with high HIV prevalence in South Africa, 2003-2007. Author: Barnighausen T; Tanser F; Newell ML Source: AIDS Research and Human Retroviruses. 2009 Apr;25(4):405-9. Abstract: To understand the dynamics of the HIV epidemic and to plan HIV treatment and prevention programs, it is critical to know how HIV incidence in a population evolves over time. We used data from a large population-based longitudinal HIV surveillance in a rural community in South Africa to test whether HIV incidence in this population has changed in the period from 2003 through 2007. We observed 563 seroconversions in 8095 individuals over 16,256 person-years at risk, yielding an overall HIV incidence of 3.4 per 100 person-years (95% confidence interval 3.1-3.7). We included time-dependent period dummy variables (in half-yearly increments) in age-stratified Cox regressions in order to test for trends in HIV incidence. We first did regression analyses separately for women and men. In both regressions, the coefficients of all period dummy variables were individually insignificant (all p > or = 0.338) and jointly insignificant (p = 0.764 and p = 0.111, respectively). We then did regression analysis using the pooled data on women and men, controlling for sex and interactions between sex and age. Again, the coefficients of the eight period dummy variables were individually insignificant (all p > or = 0.387) and jointly insignificant (p = 0.701). We show for the first time that high levels of HIV incidence have been maintained without any sign of decline over the past 5 years in both women and men in a rural South African community with high HIV prevalence. It is unlikely that the HIV epidemic in rural South Africa can be reversed without new or intensified efforts to prevent HIV infection. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | INCIDENCE | PREVALENCE | RURAL POPULATION | HIV INFECTIONS | HIV PREVENTION | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration Document Number: 341543 |
| 6. Title: Growth and nutritional status of pre-school children in India: rural-urban and gender differences. Author: Bharati P; Bharati S; Pal M; Chakrabarty S; Som S; Gupta R Source: Collegium Antropologicum. 2009 Mar;33(1):7-21. Abstract: This cross-sectional study of growth and nutritional status makes an attempt to find the gender and rural-urban differences among Indian preschool children. This study is based on the data of weight and height of children aged 0-35 months taken from 26 States (total 26,369 children; 13784 boys and 12585 girls). The children are found to be lighter and shorter compared to International standards irrespective of age and sex. Boys are heavier and taller than girls. Urban preschool children are heavier and taller compared to rural counterparts. In the urban area, higher percentages of girls are affected by underweight (37.1%) and stunting (35.0%) than boys. In rural areas, the prevalence of underweight is also higher among girls (47.9%) compared to boys (45.7%), which is found to be much significant (p < 0.01). There is a significant rural-urban as well as gender difference in growth and nutritional status of Indian preschool children. Language: English Keywords: INDIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | RURAL POPULATION | URBAN POPULATION | CHILDREN | PRIMARY SCHOOLS | GROWTH | CHILD NUTRITION | CHILD DEVELOPMENT | Asia, Southern | Asia | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Schools | Education | Biology | Nutrition | Health Document Number: 341201 |
| 7. Peer Reviewed Title: Is sexual risk taking behaviour changing in rural south-west Uganda? Behaviour trends in a rural population cohort 1993 2006. Author: Biraro S; Shafer LA; Kleinschmidt I; Wolff B; Karabalinda A; Nalwoga A; Musinguzi J; Kirungi W; Opio A; Whitworth J; Grosskurth H Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i3-i11. Abstract: Objective: To describe sexual behaviour trends in a rural Ugandan cohort in the context of an evolving HIV epidemic, 1993-2006. Methods: Sexual behaviour data were collected annually from a population cohort in which HIV serological surveys were also conducted. Behaviour trends were determined using survival analysis and logistic regression. Trends are reported based on the years in which the respective indicators were collected. Results: Between 1993 and 2006, median age at first sex increased from 16.7 years to 18.2 years among 17-20-year-old girls and from 18.5 years to 19.9 years among boys. Both sexes reported a dip in age at sexual debut between 1998 and 2001. One or more casual partners in the past 12 months among men rose from 11.6% in 1997 to 12.7% in 2004 and then declined to 10.2% in 2006. Among women it increased from 1.4% in 1997 to 3.7% in 2004 and then reduced to 1.4% in 2006. The rise in casual partners between 1997 and 2004 was driven mainly by older age groups. Trends in condom use with casual partners varied by age, increasing among those aged 35+ years, declining in the middle age groups and presenting a dip and then a rise in the youngest aged group (13-19 years). Conclusion: Among youth, risky behaviour declined but increased in the late 1990s/early 2000s. Among those aged 35+ years, condom use rose but casual partners also rose. Several indicators portrayed a temporary increase in risk taking behaviour from 1998 to 2002. Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | COHORT ANALYSIS | LONGITUDINAL STUDIES | EPIDEMIOLOGIC METHODS | RURAL POPULATION | MULTIPLE PARTNERS | SEX BEHAVIOR | RISK BEHAVIOR | HIV INFECTIONS | SEX FACTORS | FIRST INTERCOURSE | AGE FACTORS | CONDOM USE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Sexual Partners | Behavior | Viral Diseases | Diseases | Risk Reduction Behavior Document Number: 340101 |
| 8. Peer Reviewed Title: Antiretroviral adherence in rural Zambia: the first year of treatment availability. Author: Birbeck GL; Chomba E; Kvalsund M; Bradbury R; Mang'ombe C; Malama K; Kaile T; Byers PA; Organek N Author: RAAZ Study Team Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):669-74. Abstract: We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence. Language: English Keywords: ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | RURAL POPULATION | PERSONS LIVING WITH HIV/AIDS | SPOUSE | SOCIAL NETWORKS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | CLINIC VISITS | PARTNER COMMUNICATION | KNOWLEDGE | SEX FACTORS | SPOUSAL SUPPORT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Friends and Relatives | HIV | Behavior | Service Statistics | Program Activities | Programs | Organization and Administration | Interpersonal Relations | Microeconomic Factors | Economic Factors Document Number: 331277 |
| 9. Peer Reviewed Title: Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi. Author: Boileau C; Clark S; Bignami-Van Assche S; Poulin M; Reniers G; Watkins SC; Kohler HP; Heymann SJ Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i27-i33. Abstract: Objective: To explore how sexual and marital trajectories are associated with HIV infection among ever-married women in rural Malawi. Methods: Retrospective survey data and HIV biomarker data for 926 ever-married women interviewed in the Malawi Diffusion and Ideational Change Project were used. The associations between HIV infection and four key life course transitions considered individually (age at sexual debut, premarital sexual activity, entry into marriage and marital disruption by divorce or death) were examined. These transitions were then sequenced to construct trajectories that represent the variety of patterns in the data. The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region. Results: Although each life course transition taken in isolation may be associated with HIV infection, their combined effect appeared to be conditional on the sequence in which they occurred. Although early sexual debut, not marrying one's first sexual partner and having a disrupted marriage each increased the likelihood of HIV infection, their risk was not additive. Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive. Women who marry their first partner but who have sex at a young age, however, are also at considerable risk. Conclusions: These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one's life. The analysis suggests, however, the need for further data collection to permit a better examination of the mechanisms that account for variations in life course trajectories and thus in lifetime probabilities of HIV infection. Language: English Keywords: MALAWI | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | CLINICAL RESEARCH | EVER MARRIED | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREVALENCE | SEX BEHAVIOR | MARRIAGE PATTERNS | HIV INFECTIONS | FIRST INTERCOURSE | PREMARITAL SEX BEHAVIOR | DIVORCE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Marital Status | Nuptiality | Demographic Factors | Population | Economic Development | Economic Factors | Population Characteristics | Measurement | Behavior | Marriage | Viral Diseases | Diseases Document Number: 340104 |
| 10. Title: Abortion among couples in rural Bangladesh [letter] Author: Burnie R; Williams N; Robbe IJ Source: American Journal of Public Health. 2009 May;99(5):774-5; author reply 775. Abstract: Language: English Keywords: BANGLADESH | CRITIQUE | RURAL POPULATION | COUPLES | ABORTION | SAFETY | RISK FACTORS | MORTALITY | HYGIENE | Developing Countries | Asia, Southern | Asia | Population Characteristics | Demographic Factors | Population | Family Characteristics | Family and Household | Sociocultural Factors | Fertility Control, Postconception | Family Planning | Public Health | Health | Population Dynamics Document Number: 341001 |
| 11. Peer Reviewed Title: Early results of integrated malaria control and implications for the management of fever in under-five children at a peripheral health facility: a case study of Chongwe rural health centre in Zambia. Author: Chanda P; Hamainza B; Mulenga S; Chalwe V; Msiska C; Chizema-Kawesha E Source: Malaria Journal. 2009;8:49. Abstract: BACKGROUND: Zambia has taken lead in implementing integrated malaria control so as to attain the National Health Strategic Plan goal of "reducing malaria incidence by 75% and under-five mortality due to malaria by 20% by the year 2010". The strategic interventions include the use of long-lasting insecticide-treated nets and indoor residual spraying, the use of artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria, improving diagnostic capacity (both microscopy and rapid diagnostic tests), use of intermittent presumptive treatment for pregnant women, research, monitoring and evaluation, and behaviour change communication. Financial barriers to access have been removed by providing free malaria prevention and treatment services. METHODS: Data involving all under-five children reporting at the health facility in the first quarter of 2008 was evaluated prospectively. Malaria morbidity, causes of non-malaria fever, prescription patterns treatment patterns and referral cases were evaluated RESULTS: Malaria infection was found only in 0.7% (10/1378), 1.8% (251378) received anti-malarial treatment, no severe malaria cases and deaths occurred among the under-five children with fever during the three months of the study in the high malaria transmission season. 42.5% (586/1378) of the cases were acute respiratory infections (non-pneumonia), while 5.7% (79/1378) were pneumonia. Amoxicillin was the most prescribed antibiotic followed by septrin. CONCLUSION: Malaria related OPD visits have reduced at Chongwe rural health facility. The reduction in health facility malaria cases has led to an increase in diagnoses of respiratory infections. These findings have implications for the management of non-malaria fevers in children under the age of five years. Language: English Keywords: ZAMBIA | RESEARCH REPORT | CASE STUDIES | MANAGEMENT | RURAL POPULATION | CHILDREN | MALARIA PREVENTION | FEVER | PRIMARY HEALTH CARE | RESPIRATORY INFECTIONS | PREVENTION AND CONTROL | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Organization and Administration | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Malaria | Parasitic Diseases | Diseases | Body Temperature | Physiology | Biology | Health Services | Delivery of Health Care | Health | Infections Document Number: 341025 |
| 12. Peer Reviewed Title: Project AID Khmer: addressing the health impact of HIV/AIDS on Cambodia through rural capacity building. Author: Chang M; Kong NB; Phal V; Pugatch D; Allen S Source: Global Public Health. 2009 May 27;:1-12. Abstract: HIV/AIDS prevention efforts in Cambodia have largely focussed on urban populations. This focus, however, has diverted attention from the impact of the disease on rural communities, where poverty and a lack of basic infrastructure forced many to migrate to urban areas. Rural communities thus play a crucial part in the understanding of HIV/AIDS transmission dynamics in Cambodia. This paper will provide an analysis of socio-economic and health-related needs of rural communities in Cambodia, giving a different context for understanding the national burden of HIV/AIDS. These concepts will be illustrated with experiences from Project AID Khmer, a Cambodian non-governmental organisation that is working to improve Cambodian health through education programmes and community capacity building in rural Takeo province. Language: English Keywords: CAMBODIA | RESEARCH REPORT | EVALUATION | RURAL POPULATION | NONGOVERNMENTAL ORGANIZATIONS | CAPACITY BUILDING | HIV PREVENTION | SOCIOECONOMIC FACTORS | PROGRAM EVALUATION | POVERTY | AGRICULTURE | LAND TENURE | RURAL-URBAN MIGRATION | HIV TRANSMISSION | RISK FACTORS | Developing Countries | Asia, Southeastern | Asia | Population Characteristics | Demographic Factors | Population | Organizations | Political Factors | Sociocultural Factors | Program Sustainability | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Economic Factors | Macroeconomic Factors | Migration | Population Dynamics | Health Document Number: 341470 |
| 13. Title: The impact of socioeconomic and demographic variables on poverty: a village study. Author: Chaudhry IS; Malik S; ul Hassan A Source: Lahore Journal of Economics. 2009 Summer;14(1):39-68. Abstract: Poverty is a complex phenomenon based on a network of interlocking economic, social, political, and demographic factors. An understanding of the extent, nature, and determinants of rural poverty is a precondition for effective public policy to reduce poverty in rural Pakistan. The present study attempts to analyze the impact of socioeconomic and demographic characteristics of households on poverty, using primary data collected in the village ofBetti Nala in Tehsil Jatoi, district MuzaJfargarh in southern Punjab. We have used two distinct approaches: (i) a poverty profile, and (ii) an econometric approach in our empirical analysis. The results show that household size, dependency on household, participation, landholdings, and number oflivestock have a Significant impact on poverty incidence. Our final conclusion is that efforts should be made to improve socioeconomic foctors in general and demographic foctors in particular to alleviate rural poverty in remote areas of Pakistan, while land should beallotted to landless households. Language: English Keywords: PAKISTAN | RESEARCH REPORT | RURAL AREAS | RURAL POPULATION | LOW INCOME POPULATION | POVERTY | SOCIOECONOMIC FACTORS | INTERMEDIATE VARIABLES | NEEDS | IMPACT | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Population Characteristics | Demographic Factors | Social Class | Socioeconomic Status | Economic Factors | Population Dynamics | Communication Document Number: 340236 |
| 14. Title: Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal. Author: Christian P; Khatry SK; Leclerq SC; Dali SM Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 13; Abstract: OBJECTIVE: To examine the effect of supplemental prenatal folic acid, folic acid-iron, folic acid-iron-zinc, and multiple micronutrients on maternal morbidity in rural Nepal. METHODS: A cluster-randomized double-masked controlled trial of pregnant women who received daily supplements from early pregnancy through 3 months post partum as per the treatment allocation. Women were interviewed at birth about labor and delivery complications and for 9 days post partum to obtain 24-hour histories of morbidity. RESULTS: A total of 3986 (97.3%) women completed an interview regarding labor and delivery; morbidity history was available for 3564 (87.0%) women. Folic acid-iron reduced the risk of postpartum hemorrhage (relative risk [RR] 0.59; 95% confidence interval [CI] 0.35-0.98). Risk of dysfunctional labor increased with multiple micronutrient supplementation (RR 1.28; 95% CI, 1.01-1.60), although preterm premature rupture of membrane decreased (RR 0.40; 95% CI, 0.21-0.79). Puerperal sepsis was lower in those receiving folic acid-iron, folic acid-iron-zinc, and multiple micronutrients compared with controls (P<0.05). CONCLUSION: Prenatal folic acid-iron supplementation reduced the risk of obstetric complications in this South Asian setting. Language: English Keywords: NEPAL | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | CHILDBIRTH | PREGNANCY COMPLICATIONS | MATERNAL NUTRITION | FOOD SUPPLEMENTATION | PUERPERAL DISORDERS | VITAMINS AND MINERALS | FOLIC ACID | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Nutrition | Health | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Physiology | Biology Document Number: 341459 |
| 15. Peer Reviewed Title: High retention and appropriate use of insecticide-treated nets distributed to HIV-affected households in Rakai, Uganda: results from interviews and home visits. Author: Cohee L; Mills LA; Kagaayi J; Jacobs I; Galiwango R; Ludigo J; Ssekasanvu J; Reynolds SJ Source: Malaria Journal. 2009;8:76. Abstract: BACKGROUND: Distribution of insecticide-treated nets (ITNs) has recently been incorporated into comprehensive care strategies for HIV-positive people in malaria-endemic areas. WHO now recommends free or low-cost distribution of ITNs to all persons in malaria-endemic areas, regardless of age, pregnancy and HIV status. Knowledge about and appropriate use of ITNs among HIV-positive ITN recipients and their household members has not been well characterized. METHODS: 142 randomly selected adults were interviewed in July-August 2006 to assess knowledge, retention, and appropriate use of ITNs they had received through a PEPFAR-funded comprehensive HIV care programme in rural Uganda. RESULTS: Among all participants, 102 (72%, CI: 65%-79%) reported they had no ITNs except those provided by the programme. Of 131 participants who stated they were given >or= 1 ITN, 128 (98%, CI: 96%-100%) stated they still possessed at least one programme-provided ITN. Reported programme-ITN (pITN) use by participants was high: 119 participants (91%, CI: 86%-96%) reported having slept under pITN the night prior to the survey and 115 (88%, CI: 82%-94%) reported sleeping under pITN seven days per week. Being away from home and heat were the most common reasons given for not sleeping under an ITN. A sub-study of thirteen random home visits demonstrated concordance between participants' survey reports and actual use of ITNs in homes. CONCLUSION: There was excellent self-reported retention and appropriate use of ITNs distributed as a part of a community-based outpatient HIV care programme. Participants perceived ITNs as useful and were unlikely to have received ITNs from other sources. Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | HOUSEHOLDS | RURAL POPULATION | PESTICIDES | BED NETS | HOME VISITS | HIV INFECTIONS | MALARIA PREVENTION | KNOWLEDGE | PARTICIPATION | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Ingredients and Chemicals | Parasite Control | Public Health | Health | Communication | Malaria | Parasitic Diseases | Social Behavior | Behavior | Programs | Organization and Administration Document Number: 341152 |
| 16. Peer Reviewed Title: Patterns of Self-reported Behaviour Change Associated with Receiving Voluntary Counselling and Testing in a Longitudinal Study from Manicaland, Zimbabwe. Author: Cremin I; Nyamukapa C; Sherr L; Hallett TB; Chawira G; Cauchemez S; Lopman B; Garnett GP; Gregson S Source: AIDS and Behavior. 2009 Jul 22; Abstract: Voluntary counselling and testing (VCT) is promoted as a potential HIV prevention measure. We describe trends in uptake of VCT for HIV, and patterns of subsequent behaviour change associated with receiving VCT in a population-based open cohort in Manicaland, Zimbabwe. The relationship between receipt of VCT and subsequent reported behaviour was analysed using generalized linear models with random effects. At the third survey, 8.6% of participants (1,079/12,533), had previously received VCT. Women who received VCT, both those positive and negative, reduced their reported number of new partners. Among those testing positive, this risk reduction was enhanced with time since testing. Among men, no behavioural risk reduction associated with VCT was observed. Significant increases in consistent condom use, with regular or non-regular partners, following VCT, were not observed. This study suggests that, among women, particularly those who are infected, behavioural risk reduction does occur following VCT. Language: English Keywords: ZIMBABWE | RESEARCH REPORT | LONGITUDINAL STUDIES | RURAL POPULATION | HIV PREVENTION | VOLUNTARY COUNSELING AND TESTING | BEHAVIOR CHANGE | RISK REDUCTION BEHAVIOR | CONDOM USE | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior Document Number: 342278 |
| 17. Peer Reviewed Title: Validation of community health workers' assessment of neonatal illness in rural Bangladesh. Author: Darmstadt GL; Baqui AH; Choi Y; Bari S; Rahman SM; Mannan I; Ahmed AS; Saha SK; Rahman R; Chang S; Winch PJ; Black RE; Santosham M; El Arifeen S Author: Bangladesh Projahnmo-2 (Mirzapur) Study Group Source: Bulletin of the World Health Organization. 2009 Jan;87(1):12-9. Abstract: OBJECTIVE: To estimate the validity (sensitivity, specificity, and positive and negative predictive values) of a clinical algorithm as used by community health workers (CHWs) to detect and classify neonatal illness during routine household visits in rural Bangladesh. METHODS: CHWs evaluated breastfeeding and symptoms and signs of illness in 395 neonates selected randomly from neonatal illness surveillance during household visits on postnatal days 0, 2, 5 and 8. Neonates classified with very severe disease (VSD) were referred to a community-based hospital. Within 12 hours of CHW assessments, physicians independently evaluated all neonates seen in a given day by one CHW, randomly chosen from among 36 project CHWs. Physicians recorded symptoms and signs of illness, classified the illness, and determined whether the newborn needed referral-level care at the hospital. Physicians' identification and classification were used as the gold standard in determining the validity of CHWs' identification of symptoms and signs of illness and its classification. FINDINGS: CHWs' classification of VSD showed a sensitivity of 73%, a specificity of 98%, a positive predictive value of 57% and a negative predictive value of 99%. A maternal report of any feeding problem as ascertained by physician questioning was significantly associated (P < 0.001) with 'not sucking at all' and 'not attached at all' or 'not well attached' as determined clinically by CHWs during feeding assessment. CONCLUSION: CHWs identified with high validity the neonates with severe illness needing referral-level care. Home-based illness recognition and management, including referral of neonates with severe illness by CHWs, is a promising strategy for improving neonatal health and survival in low-resource developing country settings. Language: English Keywords: BANGLADESH | RESEARCH REPORT | VALIDITY | RURAL POPULATION | HEALTH PERSONNEL | NEONATAL DISEASES AND ABNORMALITIES | HOME CARE | PERFORMANCE IMPROVEMENT | CHILD SURVIVAL | CHILD HEALTH | EXAMINATIONS AND DIAGNOSES | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Diseases | Care and Support | Health Services | Management | Organization and Administration | Survivorship | Length of Life | Mortality | Population Dynamics | Medical Procedures | Medicine Document Number: 341189 |
| 18. Peer Reviewed Title: Malaria-related perceptions and practices of women with children under the age of five years in rural Ethiopia. Author: Deressa W; Ali A Source: BMC Public Health. 2009 Jul 23;9(1):259. Abstract: ABSTRACT: BACKGROUND: Malaria remains to be the major cause of morbidity and mortality among pregnant women and children in Ethiopia. The aim of this study was to investigate the local perceptions, practices and treatment seeking behaviour for malaria among women with children under the age of five years. METHODS: This community-based study was conducted in 2003 in an area of seasonal malaria transmission in Adami Tulu District, south-central Ethiopia. Total samples of 2087 rural women with children less than five years of age from 18 rural kebeles (the smallest administrative units) were interviewed about their perceptions and practices regarding malaria. In addition, focus group discussions and in-depth interviews were conducted on similar issues to complement the quantitative data. RESULTS: Malaria, locally known as busaa, is perceived as the main health problem in the study area. Mosquitoes are perceived to be the main cause of the disease, and other misperceptions were also widespread. The use of prevention measures was very low. Most mothers were familiar with the main signs and symptoms of mild malaria, and some of them indicated high grade fever, convulsions and mental confusion as a manifestation of severe malaria. Very few households (5.6%) possessed one or two nets. More than 60% of the mothers with recent episodes of malaria received initial treatment from non-public health facilities such as community health workers (CHWs) (40%) and private care providers (21%). Less than 40% of the reported malaria cases among women were treated by public health facilities. CONCLUSION: Malaria was perceived as the main health problem among women and children. The use of malaria preventive measures was low. A significant proportion of the respondents received initial malaria treatments from CHWs, private care providers and public health facilities. Concerted effort is needed to scale-up the distribution of insecticide-treated nets and improve the knowledge of the community about the link between malaria and mosquitoes. Effective antimalarial drugs should also be available at the grassroots level where the problem of malaria is rampant. Language: English Keywords: ETHIOPIA | RESEARCH REPORT | SAMPLING STUDIES | FOCUS GROUPS | MOTHERS | RURAL POPULATION | MALARIA | PERCEPTION | KNOWLEDGE | BED NETS | UTILIZATION OF HEALTH CARE | ANTIMALARIAL DRUGS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Data Collection | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Psychological Factors | Behavior | Parasite Control | Public Health | Health | Health Services | Delivery of Health Care Document Number: 342286 |
19.  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 |
| 20. Title: Micronutrient deficiencies in maternity and child health: a review of environmental and social context and implications for Malawi. Author: Dickinson N; Macpherson G; Hursthouse AS; Atkinson J Source: Environmental Geochemistry and Health. 2009 Apr;31(2):253-72. Abstract: It is well documented that micronutrient malnutrition is of increasing concern in the developing world, resulting in poor health and high rates of mortality and morbidity. During pregnancy, deficiency of iron and zinc can produce cognitive and growth impairment of the foetus, which may continue into infancy. Iron and zinc are essential micronutrients for both plant growth and human nutrition. Despite significant work in the areas of soil fertility, crop biofortification and dietary interventions, the problems of micronutrient deficiencies persist in Africa. There is a need to examine why communities have not embraced intervention strategies which may offer health benefits. Bottom-up, interdisciplinary approaches are required to effectively study the relationships between local communities and their environment, and to assess the impact their behaviour has on the cycling of micronutrients within the soil-plant-human system. From a detailed consideration of diverse influencing factors, a methodological model is suggested for studying the barriers to improving micronutrient uptake within rural communities. It combines environmental understanding with health and social factors, emphasising the need for and potential benefits of understanding and coherence in true interdisciplinary working. Language: English Keywords: MALAWI | CRITIQUE | RESEARCH PROPOSAL | METHODOLOGICAL STUDIES | INTERDISCIPLINARY STUDIES | STUDY DESIGN | RURAL POPULATION | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | INFANT | VITAMINS AND MINERALS | MATERNAL NUTRITION | INFANT NUTRITION | MALNUTRITION | SOIL DEGRADATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Youth | Age Factors | Physiology | Biology | Nutrition | Health | Nutrition Disorders | Diseases | Environmental Degradation | Environment Document Number: 341174 |
| 21. Peer Reviewed Title: Gender factors associated with sexual abstinent behaviour of rural South African high school going youth in KwaZulu-Natal, South Africa. Author: Dlamini S; Taylor M; Mkhize N; Huver R; Sathiparsad R; de Vries H; Naidoo K; Jinabhai C Source: Health Education Research. 2009 Jun;24(3):450-60. Abstract: The cross-sectional study investigated South African rural high school learners' choice of sexual abstinence in order to be able to develop tailored health education messages. All Grade 9 learners from one class at each of 10 randomly selected rural high schools participated. The Integrated Model for Motivational and Behavioural Change was used to elicit attitudes, social influences, self-efficacy and intentions towards sexual abstinence. Chi-square and t-tests were used for bivariate analysis. In total, 454 learners, mean age 16.7 years (standard deviation 1.41) range 14-20 years, participated, of whom 246 (54.2%) were female. When comparing learners reporting abstinence (n = 252) with those not abstinent (n = 202), abstinent learners were significantly more often females (P < 0.005), younger (16.5 years versus 17.1 years, P < 0.005) and drank less alcohol (P < 0.005). Abstaining girls believed that their friends and parents think that they should abstain from sex, that their friends abstained from sex and that abstinence helped them to mature emotionally. Abstinent boys expressed intentions to abstain from sex until marriage. Targeted intervention research is required to encourage South African rural high school learners to delay their sexual initiation to reduce their risk of human immunodeficiency virus infection. Different abstinent messages are needed for boys and girls to address the different patterns of behaviour observed. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | SAMPLING STUDIES | RURAL POPULATION | STUDENTS | ABSTINENCE | PREVALENCE | ATTITUDES | SEX FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Education | Family Planning, Behavioral Methods | Family Planning | Measurement | Psychological Factors | Behavior Document Number: 341430 |
| 22. Peer Reviewed Title: The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Author: Feikin DR; Nguyen LM; Adazu K; Ombok M; Audi A; Slutsker L; Lindblade KA Source: Tropical Medicine and International Health. 2009 Jan;14(1):54-61. Abstract: OBJECTIVE: To explore the impact of distance on utilisation of peripheral health facilities for sick child visits in Asembo, rural western Kenya. METHODS: As part of a demographic surveillance system (DSS), censuses of all households in the Asembo population of 55,000 are conducted three times a year, data are collected at all outpatient pediatric visits in seven DSS clinics in Asembo, and all households are GIS-mapped and linkable to a child's unique DSS identification number. Between May 1, 2003 and April 30, 2004, 3501 clinic visits were linked to 2432 children among 10,973 DSS-resident children < 5 years of age. RESULTS: Younger children and children with more severe illnesses travelled further for clinic visits. The median distance travelled varied by clinic. The rate of clinic visits decreased linearly at 0.5 km intervals up to 4 km, after which the rate stabilised. Using Poisson regression, controlling for the nearest DSS clinic for each child, socio-economic status and maternal education, and accounting for household clustering of children, for every 1 km increase in distance of residence from a DSS clinic, the rate of clinic visits decreased by 34% (95% CI, 31-37%) from the previous kilometer. CONCLUSION: Achieving equity in access to health care for children in rural Kenya will require creative strategies to address a significant distance-decay effect in health care utilisation. Language: English Keywords: KENYA | RESEARCH REPORT | DEMOGRAPHIC SURVEYS | STATISTICAL REGRESSION | RURAL POPULATION | CHILDREN | DISTANCE | HEALTH FACILITIES | UTILIZATION OF HEALTH CARE | HUMAN GEOGRAPHY | SOCIOECONOMIC STATUS | EDUCATIONAL STATUS | AGE FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Population Dynamics | Demographic Factors | Population | Data Analysis | Research Methodology | Population Characteristics | Youth | Geographic Factors | Delivery of Health Care | Health | Health Services | Geography | Social Sciences | Science | Sociocultural Factors | Socioeconomic Factors | Economic Factors Document Number: 330260 |
| 23. Peer Reviewed Title: Contraceptive use, birth spacing, and autonomy: an analysis of the Oportunidades program in rural Mexico. Author: Feldman BS; Zaslavsky AM; Ezzati M; Peterson KE; Mitchell M Source: Studies in Family Planning. 2009 Mar;40(1):51-62. Abstract: Oportunidades, a conditional cash-transfer program instituted in Mexico in 1997, provides cash incentives to mothers to invest in the health and education of family members. Drawing from data gathered by Mexico's National Institute of Public Health, this study assesses the effect of the program on contraceptive use and birth spacing among titulares (female household heads) living in rural areas during the experimental period, 1998-2000, and during 2000-03, after incorporation of the control group. In 2000, titulares were more likely to use modern contraceptives than were women in the control group, although by 2003 all beneficiaries had the same probability of use. Change in autonomy was not a mediator, although baseline autonomy modified the program's influence on contraceptive use. Cox proportional hazard models produced estimates that birth spacing was similar between the beneficiaries and controls. Inconsistent findings may be the result of the way contraceptive use was defined in this study. Findings from this study may be useful for helping program planners better understand the role of conditional cash transfers in modifying family planning and fertility among poor rural women in Latin America. Language: English Keywords: MEXICO | RESEARCH REPORT | KAP SURVEYS | LONGITUDINAL STUDIES | MATHEMATICAL MODEL | CASE CONTROL STUDIES | RURAL POPULATION | MOTHERS | WOMEN IN DEVELOPMENT | HEAD OF HOUSEHOLD | BIRTH SPACING | CONTRACEPTIVE USAGE | INCENTIVES | HOME ECONOMICS | North America | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Theoretical Models | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Economic Development | Economic Factors | Households | Family Planning | Contraception | Policy | Political Factors | Microeconomic Factors Document Number: 331287 |
| 24. Title: Conflicting accountabilities: doctor's dilemma in TB control in rural India. Author: Fochsen G; deshpande K; Ringsberg KC; Thorson A Source: Health Policy. 2009 Feb;89(2):160-167. Abstract: The aim of this study was to analyse how the implementation strategy of direct observed treatment short course (DOTS) has shaped and influenced patient-provider encounters in a district tuberculosis centre (DTC) in a rural district of India. Method: Qualitative methods, combining observations and interviews, were carried out in a DTC focusing on the medical encounters between a TB doctor and his patients. Results: The findings showed that the TB doctor seemed to be working with a dilemma, defined as conflicting accountabilities, in the medical encounters. In an organization perceived as inefficient and resource-constrained, the doctor struggled to find a balance between meeting the obligations of the DOTS programme and meeting the needs and expectations of the patients. Strategies to deal with these conflicting accountabilities were identified as limiting patients' involvement, struggling to maintain authority, and transferring responsibility. Conclusion: Professional involvement and patient participation were seen as part of a linked process in this study, and the importance of empowering doctors and health care workers who are implementing DOTS is emphasized. The development of DOTS guidelines needs to be based on the actual process of health care delivery, and staff empowering efforts should also include strengthening of public health care infrastructure. Language: English Keywords: INDIA | RESEARCH REPORT | RURAL POPULATION | PHYSICIAN-PATIENT RELATIONS | CLIENTS | TUBERCULOSIS | DIRECTLY OBSERVED THERAPY SHORT-COURSE (DOTS) | Developing Countries | Asia, Southern | Asia | Population Characteristics | Demographic Factors | Population | Interpersonal Relations | Behavior | Program Activities | Programs | Organization and Administration | Infections | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330192 |
| 25. Title: Hematologic changes associated with zidovudine following single-drug substitution from stavudine in a home-based AIDS care program in rural Uganda. Author: Forna F; Moore D; Mermin J; Brooks JT; Were W Source: Journal of the International Association of Physicians in AIDS Care. 2009 Mar-Apr;8(2):128-138. Abstract: Background. The authors evaluated hematologic changes associated with zidovudine (ZDV) following single-drug substitution from stavudine (D4T) in HIV-infected persons in Uganda. Methods. From May 2003 through February 2007, the authors evaluated incidence rates (IR) of hematologic abnormalities from quarterly blood draws among adults prescribed highly active antiretroviral therapy (HAART) before and after single-drug substitution of D4T to ZDV. Results. A total of 1089 adults received D4T-containing HAART (median observation time 35.9 months), and 290 (27%) had ZDV substituted for D4T. While taking D4T, IR for anemia was 0.35/100 person-months (PMs), leukopenia was 0.29/100PM, and thrombocytopenia was 0.32/100 PM. While taking ZDV, IR for anemia was 0.44/100 PM, leukopenia was 1.05/100 PM, and thrombocytopenia was 0.30/100 PM. Conclusions. Patients had a higher incidence of anemia and leukopenia after substitution from D4T to ZDV, but hematologic toxicity was not a major complication in this population. Patients on ZDV-containing HAART regimens are still at risk for anemia and need close monitoring. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | ADULTS | RURAL POPULATION | HIV INFECTIONS | PREVALENCE | HOME CARE | ANTIRETROVIRAL THERAPY | HEMIC SYSTEM | SIDE EFFECTS | THROMBOSIS | ANEMIA | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Care and Support | Health Services | Delivery of Health Care | Health | HIV | Physiology | Biology | Treatment | Medical Procedures | Medicine | Thromboembolism | Embolism | Vascular Diseases Document Number: 331335 |
| 26. 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 |
| 27. Peer Reviewed Title: Successful integration of tuberculosis and HIV treatment in rural South Africa: the Sizonq'oba study. Author: Gandhi NR; Moll AP; Lalloo U; Pawinski R; Zeller K; Moodley P; Meyer E; Friedland G Author: Tugela Ferry Care and Research (TFCaRes) Collaboration Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Jan 1;50(1):37-43. Abstract: BACKGROUND: Tuberculosis (TB) is the leading cause of death among HIV-infected patients worldwide. In KwaZulu-Natal, South Africa, 80% of TB patients are HIV coinfected, with high treatment default and mortality rates. Integrating TB and HIV care may be an effective strategy for improving outcomes for both diseases. METHODS: Prospective operational research study treating TB/HIV-coinfected patients in rural KwaZulu-Natal with once-daily antiretroviral (ARV) therapy concurrently with TB therapy by home-based, modified directly observed therapy. Patients were followed for 12 months after ARV initiation. RESULTS: Of 119 TB/HIV-coinfected patients enrolled, 67 (56%) were female, mean age was 34.0 years, and median CD4 count was 78.5 cells per cubic millimeter. After 12 months on ARVs, mean CD4 count increase was 211 cells per cubic millimeter, and 88% had an undetectable viral load; 84% completed TB treatment. Thirteen patients (11%) died; 10 (77%) with multidrug-resistant or extensively drug-resistant TB. There were few severe adverse events or immune reconstitution events. Adherence was high with 93% of study visits attended and 99% of ARV doses taken. CONCLUSIONS: Integration of TB and HIV treatment in a rural setting using concurrent home-based therapy resulted in excellent adherence and TB and HIV outcomes. This model may result in successful management of both diseases in other rural resource-poor settings. Language: English Keywords: SOUTH AFRICA | EVALUATION REPORT | PROSPECTIVE STUDIES | OPERATIONS RESEARCH | PERSONS LIVING WITH HIV/AIDS | RURAL POPULATION | INTEGRATED PROGRAMS | TUBERCULOSIS | AIDS PREVENTION | TREATMENT | RURAL HEALTH SERVICES | COMPLICATIONS | ANTIRETROVIRAL THERAPY | HOME VISITS | DRUG RESISTANCE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Evaluation | Studies | Research Methodology | Program Evaluation | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Infections | AIDS | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Communication Document Number: 330981 |
| 28. Peer Reviewed Title: Herpes simplex virus-2 infection in male rural migrants in Shanghai, China. Author: He N; Cao H; Yin Y; Gao M; Zhang T; Detels R Source: International Journal of STD and AIDS. 2009 Feb;20(2):112-4. Abstract: The overall herpes simplex virus (HSV)-2 seroprevalence was 5.5% among male rural migrants working in construction sites, markets and factories, 5.4% among those reporting having had sexual intercourse and 5.8% among those reporting no sexual intercourse. Multiple logistic regression analyses indicate that migrants having higher income were more likely to have HSV-2 infection. None of the HSV-2-positives realized their infection status. Future sexually transmitted disease (STD) intervention programmes should target migrants with higher income and migrant market vendors and should not exclude those who self-report no STDs or no history of sexual intercourse. Language: English Keywords: CHINA | RESEARCH REPORT | RURAL POPULATION | MIGRANT WORKERS | MEN | HERPES GENITALIS | SEXUALLY TRANSMITTED DISEASES | Asia, Eastern | Asia | Developing Countries | Population Characteristics | Demographic Factors | Population | Labor Force | Human Resources | Economic Factors | Reproductive Tract Infections | Infections | Diseases Document Number: 331171 |
| 29. Title: Condom use among married women at risk for sexually transmitted infections and HIV in rural China. Author: Hong H; Qin QR; Li LH; Ji GP; Ye DQ Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 13; Abstract: OBJECTIVE: To assess factors associated with condom use among married women in rural China, and provide evidence for implementing education strategies to prevent sexually transmitted infections and HIV. METHODS: A total of 737 sexually active married rural women who were aged between 18 and 49 years and had heard of AIDS were selected by cluster sampling and interviewed in 8 villages of Anhui province, China. RESULTS: The rate of condom use was only 5.4%.There were no significant differences in sexual behavior and condom use between married women whose husbands were away as migrant workers and the wives of nonmigrant men, except in knowledge of free condom sources. Significant factors associated with condom use included age, level of education, knowledge about condoms, training about condoms, sources of condoms, and husbands' attitude toward condoms. CONCLUSIONS: More educational interventions are needed to increase condom knowledge and promotion, especially among less educated women and married women left behind by migrant husbands. Language: English Keywords: CHINA | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE SURVEYS | WOMEN IN DEVELOPMENT | RURAL POPULATION | CURRENTLY MARRIED | MIGRANT WORKERS | SPOUSE | CONDOM USE | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | AGE FACTORS | EDUCATIONAL STATUS | ATTITUDES | KNOWLEDGE | Asia, Eastern | Asia | Developing Countries | Family Planning Surveys | Family Planning | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Marital Status | Nuptiality | Labor Force | Human Resources | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Risk Reduction Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Socioeconomic Status | Socioeconomic Factors | Psychological Factors Document Number: 341460 |
| 30. Title: Long-term follow-up of a peer-led HIV/AIDS prevention program for married women in rural China. Author: Hong H; Ji GP; Ye DQ Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 3; Abstract: Women are infected with HIV at increasing rates worldwide, and the incidence of new AIDS cases has been rising faster for women than for men. In China, rural married women may become infected with HIV and other sexually transmitted infections (STIs) when their husbands return home after working in cities. Studies have demonstrated that many married rural women know little about condom use or STIs, and that their low level of knowledge puts them at risk. Since HIV is mainly sexually transmitted and there is neither an effective vaccine nor a cure for HIV/AIDS, the most important way to control HIV/AIDS is to decrease high-risk sexual behavior by improving women's HIV/AIDS-related knowledge and attitudes. In 2007 and 2008, we conducted a follow-up study with 737 married women in North Anhui, China, to evaluate the long-term effects of a peer education program for married women. (excerpt) Language: English Keywords: CHINA | RESEARCH REPORT | KAP SURVEYS | FOLLOW-UP STUDIES | CURRENTLY MARRIED | WOMEN IN DEVELOPMENT | PEER EDUCATORS | RURAL POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV PREVENTION | LONGTERM EFFECTS | CONDOM USE | KNOWLEDGE | ATTITUDES | Asia, Eastern | Asia | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Marital Status | Nuptiality | Demographic Factors | Population | Economic Development | Economic Factors | Education | Population Characteristics | HIV Infections | Viral Diseases | Diseases | Time Factors | Population Dynamics | Risk Reduction Behavior | Behavior | Sociocultural Factors | Psychological Factors Document Number: 341463 |
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