Photo: During an antenatal care visit, a pregnant woman in Ahentia, Ghana, gets her blood pressure checked. Frequent antenatal care is important for identifying women who may be at risk for pre-eclampsia or eclampsia, which not only is responsible for about 14% of maternal deaths but also is an underlying cause of an estimated 10%–25% of late fetal and early neonatal death. ©2014 BBC.
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.
December 2015 | Volume 3 | Issue 4
- Can a mobile application effectively be used to track Ebola contacts?
- How can we improve a wide range of health behaviors when some behaviors change rapidly and others slowly?
- Can the levonorgestrel intrauterine system be a "game-changer" for improving contraceptive choice in Africa?
- What impact does voluntary medical male circumcision have on the sexual satisfaction of Zambian men and their partners?
- How were motor vehicle injuries reduced in American Indian and Alaska Native communities in the United States?
- What factors are associated with increased productivity in family planning service sites in Kinshasa, DRC?
Read the December 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.
TABLE OF CONTENTS
An intensive radio campaign in rural areas of Burkina Faso addressed multiple key behaviors to reduce child mortality, using a randomized cluster design. After 20 months, despite innovative approaches and high reported listenership, only modest reported change in behavior was found, mainly related to care seeking rather than habitual behavior such as hand washing. Various methodologic difficulties may have obscured a true greater impact. Analysis of the intervention after its full 35-month duration may reveal more impact, including on actual child mortality. Improving a number of key behaviors is essential to child survival efforts, and much of it may require strong and sustained efforts.
Pre-eclampsia is a major underlying cause of late fetal and early neonatal death, accounting for somewhere between 1 in 10 and 1 in 4 perinatal deaths; it warrants greater efforts from the maternal-newborn community.
Reduced Effectiveness of Contraceptive Implants for Women Taking the Antiretroviral Efavirenz (EFV): Still Good Enough and for How Long?
EFV clearly reduces effectiveness of implants. However, the reduced effectiveness still appears better compared with short-acting methods overall, at least for the initial period of implant use, and may be acceptable to many women. We need better data on effectiveness, especially over the long term and on whether ENG implants (Implanon) might be more effective than LNG implants (Jadelle). Communicating the risk of pregnancy to clients under these circumstances is very challenging. In the longer term, providing an alternative to EFV, such as dolutegravir, might solve this problem.
James D Shelton
The levonorgestrel intrauterine system has: (1) excellent effectiveness, (2) high satisfaction levels, (3) non-contraceptive benefits, and (4) potential to help reinvigorate interest in intrauterine contraception. The time is ripe for ministries and donor agencies to work together to make the product widely available across Africa.
The levonorgestrel intrauterine system (LNG IUS) has major advantages and could be a "game-changer" in improving contraceptive choice and use. It faces important challenges, however, including: (1) high commodity cost; (2) often-strong provider resistance to IUDs and difficult programmatic requirements; (3) need for demand creation, including assessing if markedly reduced menstrual bleeding is attractive to clients; and (4) the many requirements for introducing any new contraceptive. A good next step would be a well-focused and multifaceted "learning introduction" to assess the LNG IUS's potential in several low-income countries, with rapid scale-up if results are promising.
Roy Jacobstein, James D Shelton
The Saturation+ Approach to Behavior Change: Case Study of a Child Survival Radio Campaign in Burkina Faso
This randomized radio campaign focused on the 3 principles of the Saturation+ approach to behavior change: (1) saturation (high exposure to messages), (2) science (basing design on data and modeling), and (3) creative storytelling. Locally developed short spots and longer dramas targeted multiple child survival-related behaviors and were delivered entirely by local radio stations. Innovative partnerships with radio stations provided free airtime in return for training, equipment, and investment in solar power.
Joanna Murray, Pieter Remes, Rita Ilboudo, Mireille Belem, Souleymane Salouka, Will Snell, Cathryn Wood, Matthew Lavoie, Laurent Deboise, Roy Head
Behavior Change After 20 Months of a Radio Campaign Addressing Key Lifesaving Family Behaviors for Child Survival: Midline Results From a Cluster Randomized Trial in Rural Burkina Faso
The radio campaign reached a high proportion of mothers, but the impact on self-reported behaviors at midline was mixed. Some reported episodic behaviors such as care seeking for diarrhea and obtaining treatment for fast/difficult breathing improved more in intervention than control areas, but there was little or no difference between areas in reported habitual behaviors, such as exclusive breastfeeding, complementary feeding, hand washing with soap, and use of bed nets.
Sophie Sarrassat, Nicolas Meda, Moctar Ouedraogo, Henri Some, Robert Bambara, Roy Head, Joanna Murray, Pieter Remes, Simon Cousens
Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana
Most respondents thought the number of ambulances insufficient and said they would rather use a taxi—perceived to be faster—in a medical emergency. Nevertheless, people generally had favorable attitudes of existing public ambulance services, although few knew of the toll-free emergency number and many thought it appropriate to use ambulances to transport corpses. Targeted public education, along with improved capacity of ambulance agencies to handle increased caseload, could improve use.
Nee-Kofi Mould-Millman, Sarah D Rominski, Joshua Bogus, Adit A Ginde, Ahmed N Zakariah, Christiana A Boatemaah, Arthur H Yancey, Samuel Kaba Akoriyea, Thomas B Campbell
Monitoring and evaluating large-scale global health program transitions can strengthen accountability, facilitate stakeholder engagement, and promote learning about the transition process and how best to manage it. We propose a conceptual framework with 4 main domains relevant to transitions—leadership, financing, programming, and service delivery—along with guiding questions and illustrative indicators to guide users through key aspects of monitoring and evaluating transition. We argue that monitoring and evaluating transitions can bring conceptual clarity to the transition process, provide a mechanism for accountability, facilitate engagement with local stakeholders, and inform the management of transition through learning.
James Bao, Daniela C Rodriguez, Ligia Paina, Sachiko Ozawa, Sara Bennett
Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project
Most men and their partners reported increased or the same levels of sexual pleasure and improved or no change in penile hygiene post-VMMC. While half of men reported increased or no change in sexual functioning (orgasm, erections), one-third reported a decrease. Early resumption of sexual intercourse prior to complete healing was most closely associated with adverse outcomes, including decreased sexual functioning, satisfaction, and desire.
Robert Zulu, Deborah Jones, Ndashi Chitalu, Ryan Cook, Stephen Weiss
Reducing Motor Vehicle-Related Injuries at an Arizona Indian Reservation: Ten Years of Application of Evidence-Based Strategies
Motor vehicle crashes decreased and seat belt use, including car seat use, increased in an American Indian and Alaska Native community through a multidisciplinary approach using strong partnerships among public health and law enforcement agencies; community outreach; mass media campaigns; and enactment and high-visibility enforcement of key laws, such as lowering the legal blood alcohol concentration limit for drivers and mandating use of occupant restraints.
Stephen R Piontkowski, Jon S Peabody, Christine Reede, Jose´ Velascosoltero, Gordon Tsatoke Jr, Timothy Shelhamer, Kenny R Hicks
Family Planning Supply Environment in Kinshasa, DRC: Survey Findings and Their Value in Advancing Family Planning Programming
A series of facility-based surveys that mapped all sites providing family planning services and that assessed readiness to provide services, using mobile phones, was feasible in a low-resource setting, contributing to mobilization of partners and increased donor support. Between 2012 and 2013, readiness to provide services increased from 44% of sites to 63%. Three factors most associated with productivity: type of facility (clinics more than hospitals or health centers), more years in operation, and number of methods available.
Patrick Kayembe, Saleh Babazadeh, Nelly Dikamba, Pierre Akilimali, Julie Hernandez, Arsene Binanga, Jane T Bertrand
An informatics system consisting of a mobile health application and business intelligence software was used for collecting and analyzing Ebola contact tracing data. This system offered potential to improve data access and quality to support evidence-based decision making for the Ebola response in Guinea. Implementation challenges included software limitations, technical literacy of users, coordination among partners, government capacity for data utilization, and data privacy concerns.
Jilian A Sacks, Elizabeth Zehe, Cindil Redick, Alhoussaine Bah, Kai Cowger, Mamady Camara, Aboubacar Diallo, Abdel Nasser Iro Gigo, Ranu S Dhillon, Anne Liu
Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Lessons From a Pilot Program in Northern Karnataka, India
Trained nurse mentors catalyzed quality improvements in facility-based maternal and newborn care by: (1) encouraging use of self-assessment checklists and team-based problem solving, (2) introducing case sheets to ensure adherence to clinical guidelines, and (3) strengthening clinical skills through on-site demonstrations and bedside teaching. Inadequate leadership and staffing were challenges in some facilities. Some social norms, such as client resistance to referral and to staying 48 hours after delivery, also impact quality and mandate community mobilization efforts.
Elizabeth A Fischer, Krishnamurthy Jayana, Troy Cunningham, Maryann Washington, Prem Mony, Janet Bradley, Stephen Moses
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