Latest Articles
- Declining HIV Prevalence in Parallel With Safer Sex Behaviors in Burkina Faso: Evidence From Surveillance and Population-Based Surveys
HIV prevalence among pregnant women ages 15–49 declined from 7.1% to 2.0% in urban areas between 1998 and 2014, and from 2.0% to 0.5% in rural areas between 2003 and 2014; similar declines were reported in the Demographic and Health Surveys. During the same time period, individuals reported safer sex behaviors, including delayed sexual debut and reduced number of sex partners among youth, as well as increased condom use at last sex with nonmarital partners among men and women ages 15–49.
- Leading With LARCs in Nigeria: The Stars Are Aligned to Expand Effective Family Planning Services Decisively
Despite years of family planning effort in Nigeria, the modern contraceptive prevalence (mCPR) has reached only 10%. Yet a few recent seminal, well-executed programs have been outstandingly successful providing long-acting reversible contraceptives (LARCs)—both in the public and private sector, and in the North and South. Remarkably, the LARCs they provided were equivalent to 2% mCPR in 2015 alone.
Accordingly, we advocate markedly increased support for: (1) private-sector approaches such as social franchising, particularly in the South, (2) mobile outreach, and (3) support to public clinical facilities, including expanding access through community health extension workers (CHEWs), particularly in the North. Success will require system support, quality, and concerted engagement from a variety of partners including the Government of Nigeria.
Without significant progress in Nigeria, the global FP2020 goal appears unattainable. Fortunately, leading with LARCs along with wide choice of other methods provides a clear avenue for success.
- A Convenient Truth: Cost of Medications Need Not Be a Barrier to Hepatitis B Treatment
Drugs that are inexpensive to manufacture and simple to administer greatly expand the potential to help tens of millions of people who need treatment for chronic hepatitis B virus (HBV) infection. Key program implementation challenges include identifying who would benefit from antiviral medication and ensuring long-term and consistent treatment to people who feel well. The best opportunities are where health systems are advanced enough to effectively address these challenges and in settings where HIV service platforms can be leveraged. Research, innovation, and collaboration are critical to implement services most efficiently and to realize economies of scale to drive down costs of health care services, drugs, and diagnostics.
- Success Providing Postpartum Intrauterine Devices in Private-Sector Health Care Facilities in Nigeria: Factors Associated With Uptake
41% of women delivering in the social franchise private facilities chose the postpartum IUD. Factors associated with acceptance included lower education, higher parity, and being single. Scale-up of postpartum IUD services in both public and private facilities has the potential to significantly increase use of long-acting reversible contraception in Nigeria.
- Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program
From 2011 to 2015, a diarrhea management program in Ghana targeting pharmaceutical suppliers, private-sector providers, and caregivers successfully increased caregiver use of oral rehydration salts (ORS) with zinc to treat diarrhea in children under 5, from 0.8% to 29.2%, and reduced antibiotic use (which is generally inappropriate for treatment of non-bloody diarrhea) from 66.2% to 38.2%.
- Partnerships for Policy Development: A Case Study From Uganda’s Costed Implementation Plan for Family Planning
The development and launch of the costed implementation plan (CIP) in Uganda was successful in many ways. However, it would have benefitted from more focus on long-term partnership development critical for executing the CIP and by including district health officers—key players in executing the plan—more substantially in the process. Using a partnership approach sets the stage for ensuring that the right people are contributing to both development and execution.
- Factors Associated With Community Health Worker Performance Differ by Task in a Multi-Tasked Setting in Rural Zimbabwe
Programs should consider specific tasks and how they relate to health worker factors, community support, and the work context. In a setting where community health workers were responsible for multiple tasks, those who referred more pregnant women were female, unmarried, under 40 years old, and from larger households, and they felt they had adequate work resources and positive feedback from supervisors and the community. In contrast, workers with high scores on delivering household behavior change lessons were from smaller households and received more supportive supervision.
- Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries
Many program implementers have difficulty collecting and analyzing data on program beneficiaries’ wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.
- Birthing Centers Staffed by Skilled Birth Attendants: Can They Be Effective … at Scale?
Peripheral-level birthing centers may be appropriate and effective in some circumstances if crucial systems requirements can be met. But promising models don’t necessarily scale well, so policy makers and program managers need to consider what requirements can and cannot be met feasibly at scale. Apparently successful components of the birthing center model, such as engagement of traditional birth attendants and use of frontline staff who speak the local language, appear conducive to use in other similar settings.
- Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis
In general, across the developing world, wealthier women are more likely than poorer women to use long-acting and permanent methods of contraception instead of short-acting methods. Exceptions are Bangladesh, India, and possibly Haiti.