GHSP Journal, Volume 3, Issue 3 – Sharing Experiences and Results from the Global Health Community

Photo: A Care Group Promoter from Bangladesh teaches the volunteers she oversees new health  promotion messages that they will share with their neighbors. © 2013, Ayan Shankar Seal/Project Care International.

Global Health: Science and Practice (GHSP), a no-fee, peer-reviewed, open-access journal, is targeted to global health professionals, particularly program implementers, to validate their experiences and program results by peer reviewers and to share them with the greater global health community.

September 2015 | Volume 3 | Issue 3

• What are the first evidence-based, empirically derived tools to assess dehydration in children?
• Should institutional care of orphaned children be phased out in low- and middle-income settings?
• Can Care Group Volunteers improve maternal and child health outcomes through women's groups?
• What doesn't work in adolescent sexual and reproductive health?
• Is the gap between the rich and the poor in reproductive health closing?
• As the human "arc of life" continues to expand, how will it affect economies and societal structures?
• Can community health extension workers in Nigeria safely and effectively provide contraceptive implants?

Read the September 2015 issue of GHSP to find answers to these questions and more. View a list of all articles by article type below or online.

Visit the GHSP website to read and comment on the articles, and subscribe to receive alerts when new articles and issues are published.

EDITORIALS

Women's Groups to Improve Maternal and Child Health Outcomes: Different Evidence Paradigms Toward Impact at Scale

The Care Group model, with relatively intensive international NGO implementation at moderate scale, appears successful in a wide variety of settings, as assessed by high-quality evaluation with rich program learning. Another women's group approach—Participatory Women's Groups—has also been implemented across various settings but at smaller scale and assessed using rigorous RCT methodology under controlled—but less naturalistic—conditions with generally, although not uniformly, positive results. Neither approach, as implemented to date, is directly applicable to large-scale integration into current public programs. Our challenge is to distill the elements of success across these approaches that empower women with knowledge, motivation, and increased self-efficacy—and to apply them in real-world programs at scale.

Global Health: Science and Practice

Task Sharing Implant Insertion by Community Health Workers: Not Just Can It Work, but How Might It Work Practically and With Impact in the Real World

Demonstrating that a health service, such as providing contraceptive implants, can be safely task shared to less highly trained workers is crucial but is only one step toward effective implementation at scale. Providers need dedicated time, enough clients, supplies, supervision, and other system support, allowing them to maintain their competency, confidence, and productivity.

Lois Schaefer

Institutional Care of Children in Low- and Middle-Income Settings: Challenging the Conventional Wisdom of Oliver Twist

Whether institutions or extended families are better suited to care for orphans depends on the specific circumstances. Reported rates of traumatic experiences among orphans and vulnerable children are high in both institutions and extended families; improving the quality of care for such children should be the paramount priority in all settings.

Paula Braitstein

COMMENTARIES

What Does Not Work in Adolescent Sexual and Reproductive Health: A Review of Evidence on Interventions Commonly Accepted as Best Practices

Youth centers, peer education, and one-off public meetings have generally been ineffective in facilitating young people's access to sexual and reproductive health (SRH) services, changing their behaviors, or influencing social norms around adolescent SRH. Approaches that have been found to be effective when well implemented, such as comprehensive sexuality education and youth-friendly services, have tended to flounder as they have considerable implementation requirements that are seldom met. For adolescent SRH programs to be effective, we need substantial effort through coordinated and complementary approaches. Unproductive approaches should be abandoned, proven approaches should be implemented with adequate fidelity to those factors that ensure effectiveness, and new approaches should be explored, to include greater attention to prevention science, engagement of the private sector, and expanding access to a wider range of contraceptive methods that respond to adolescents' needs.

Venkatraman Chandra-Mouli, Catherine Lane, Sylvia Wong

The Demographic Stretch of the Arc of Life: Social and Cultural Changes That Follow the Demographic Transition

The demographic transition from high to low levels of mortality and fertility brings about changes that stretch the "arc of life," making each stage of life longer and creating new ones—a phenomenon we call "the demographic stretch." This stretch can transform societal structure, for example, by extending childhood, shifting working ages up, delaying marriage and childbearing, improving women's status and equity, and pushing the burden of chronic disease and disability to older ages. Global health efforts must address the resultant economic and social changes.

Ariel Pablos-Mendez, Scott R Radloff, Kamiar Khajavi, Sally Ann Dunst

VIEWPOINTS

WHO Tiered-Effectiveness Counseling Is Rights-Based Family Planning

Contraceptive effectiveness is the leading characteristic for most women when choosing a method, but they often are not well-informed about effectiveness of methods. Because of the serious consequences of "misinformed choice," counseling should proactively discuss the most effective methods—long-acting reversible contraceptives and permanent methods—using the WHO tiered-effectiveness model.

John Stanback, Markus Steiner, Laneta Dorflinger, Julie Solo, Willard Cates, Jr

ORIGINAL ARTICLES

Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings

Care Groups use volunteers to motivate mothers to adopt key MCH behaviors. The volunteers meet as a group every 2–4 weeks with a paid facilitator to learn new health promotion messages. Key ingredients of the approach include: peer-to-peer health promotion, selection of volunteers by the mothers, a manageable workload for the volunteers (no more than 15 households per volunteer), frequent (at least monthly) contact between volunteers and mothers, and regular supervision of the volunteers.

Henry Perry, Melanie Morrow, Sarah Borger, Jennifer Weiss, Mary DeCoster, Thomas Davis, Pieter Ernst

Care Groups II: A Summary of the Child Survival Outcomes Achieved Using Volunteer Community Health Workers in Resource-Constrained Settings

Care Group projects resulted in high levels of healthy behavior, including use of oral rehydration therapy, bed nets, and health care services. Accordingly, under-5 mortality in Care Group areas declined by an estimated 32% compared with 11% in areas with child survival projects not using Care Groups.

Henry Perry, Melanie Morrow, Thomas Davis, Sarah Borger, Jennifer Weiss, Mary DeCoster, Jim Ricca, Pieter Ernst

Task Shifting Provision of Contraceptive Implants to Community Health Extension Workers: Results of Operations Research in Northern Nigeria

With training and supportive supervision, male and female Community Health Extension Workers (CHEWs) in Nigeria safely and effectively provided contraceptive implants, and virtually all clients said they were satisfied. Most CHEWs achieved competency after 5 client insertions. However, the CHEWs provided only an average of 4 insertions per health facility per month. Realizing the true potential of providing implants calls for a context with dedicated providers and robust outreach.

Zulfiya Charyeva, Olugbenga Oguntunde, Nosa Orobaton, Emmanuel Otolorin, Fatima Inuwa, Olubisi Alalade, Dele Abegunde, Saba'atu Danladi

Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study

Contrary to some conventional wisdom, in this large study that randomly sampled orphans and separated children from 5 countries, prevalence of reported traumatic events was no worse among those institutionalized than among those in family-based care. Reported incidence of physical or sexual abuse was actually higher for those in family-based care. Understanding the specific context, and elements contributing to potential harm and benefits in both family-based and institutional care, are essential to promoting the best interest of the child.

Christine L Gray, Brian W Pence, Jan Ostermann, Rachel A Whetten, Karen O'Donnell, Nathan M Thielman, Kathryn Whetten

Empirically Derived Dehydration Scoring and Decision Tree Models for Children With Diarrhea: Assessment and Internal Validation in a Prospective Cohort Study in Dhaka, Bangladesh

The DHAKA Dehydration Score and the DHAKA Dehydration Tree are the first empirically derived and internally validated diagnostic models for assessing dehydration in children with acute diarrhea for use by general practice nurses in a resource-limited setting. Frontline providers can use these new tools to better classify and manage dehydration in children.

Adam C Levine, Justin Glavis-Bloom, Payal Modi, Sabiha Nasrin, Soham Rege, Chieh Chu, Christopher H Schmid, Nur H Alam

Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries

In light of advocacy efforts to reach the poorest with better health services, an examination of recent history reveals that overall the poor-rich gap in contraceptive use is already narrowing substantially, and more so where family planning programs are stronger. For most of 18 other reproductive health indicators, the gap is also narrowing. However, contraceptive use gaps in many sub-Saharan African countries have not diminished, calling for strong family planning program efforts to improve equity.

John Ross

Regulatory Monitoring of Fortified Foods: Identifying Barriers and Good Practices

Food fortification with micronutrients often is not compliant with relevant standards, in large part because poor regulatory monitoring does not sufficiently identify and hold producers accountable for underfortified products. We propose these reinforcing approaches: clear legislation, government leadership, strong enforcement of regulations, improved financial and human capacity at the regulatory agency and industry levels, civil society engagement, simplified monitoring processes, and relationship building between industry and government.

Corey L Luthringer, Laura A Rowe, Marieke Vossenaar, Greg S Garrett

Estimating Contraceptive Prevalence Using Logistics Data for Short-Acting Methods: Analysis Across 30 Countries

Three models showed strong correlation between public-sector logistics data for injectables, oral contraceptives, and condoms and their prevalence rates, demonstrating that current logistics data can provide useful prevalence estimates when timely survey data are unavailable.

Marc Cunningham, Ariella Bock, Niquelle Brown, Suzy Sacher, Benjamin Hatch, Andrew Inglis, Dana Aronovich

The Astronomy of Africa's Health Systems Literature During the MDG Era: Where Are the Systems Clusters?

The volume of literature on health systems in sub-Saharan Africa has been expanding since the 2000 MDG era. Focus has remained generally on categorical health themes rather than systems concepts. Topics such as scaling-up, organizational development, data use for decision making, logistics, and financial planning remain underrepresented. And quite surprisingly, implementation science remains something of a "black hole." But bibliometric evidence suggests there is a shift in focus that may soon address these gaps.

James F Phillips, Mallory Sheff, Christopher B Boyer

FIELD ACTION REPORTS

Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania

Interactive GIS maps created by overlapping facility data including roads and infrastructure with population and service delivery data permitted strategic deployment of mobile voluntary medical male circumcision (VMMC) services to underserved rural communities. The percentage of VMMCs performed in rural areas jumped from 48% in 2011 to 93% in 2014.

Hally Mahler, Sarah Searle, Marya Plotkin, Yusuph Kulindwa, Seth Greenberg, Erick Mlanga, Emmanuel Njeuhmeli, Gissenje Lija

INNOVATIONS

Remote Sensing of Vital Signs: A Wearable, Wireless "Band-Aid" Sensor With Personalized Analytics for Improved Ebola Patient Care and Worker Safety

This wireless sensor technology, currently being field-tested in an Ebola Treatment Unit in Sierra Leone, monitors multiple vital signs continuously and remotely. When connected with enhanced analytics software, it can discern changes in patients' status much more quickly and intelligently than conventional periodic monitoring, thus saving critical health care worker time and reducing exposure to pathogens.

Steven R Steinhubl, Mark P Marriott, Stephan W Wegerich