Latest Articles
- 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.
- 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.
- 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.
- 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.
- Private-Sector Social Franchising to Accelerate Family Planning Access, Choice, and Quality: Results From Marie Stopes International
In just 7 years, Marie Stopes International (MSI) has scaled-up social franchising across Africa and Asia, from 7 countries to 17, cumulatively reaching an estimated 3.75 million clients including young adults and the poor. In 2014, 68% of clients chose long-acting reversible contraceptives, and many clients were adopters of family planning. Service quality and efficiency (couple-years of protection delivered per outlet) also improved significantly.
- How Can We Better Evaluate Complex Global Health Initiatives? Reflections From the January 2014 Institute of Medicine Workshop
An IOM workshop on evaluation design drew on recent evaluations of 4 complex initiatives (PEPFAR; the Global Fund to Fight AIDS, TB and Malaria; the President's Malaria Initiative; and the Affordable Medicines Facility-malaria). Key components for good evaluations: (1) a robust theory of change to understand how and why programs should work; (2) use of multiple analytic methods; and (3) triangulation of evidence to validate and deepen understanding of results as well as synthesis of findings to identify lessons for scale-up or broader application.
- PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean
Six key steps for effective transition: (1) develop a roadmap; (2) involve stakeholders; (3) communicate the plan; (4) support midterm evaluations; (5) strengthen financial, technical, and management capacity; and (6) support ongoing M&E. The Eastern Caribbean will need to identify HIV champions; strengthen leadership and management; improve policies to protect key populations; engage the private sector and civil society more; integrate HIV programs into primary care; improve supply chain capacity; and address health worker shortages.
- Appropriate Management of Acute Diarrhea in Children Among Public and Private Providers in Gujarat, India: A Cross-Sectional Survey
Training public-sector providers to treat diarrhea in children with low-osmolarity oral rehydration salts and zinc appeared to be effective. Among private providers, drug-detailing visits by pharmaceutical representatives seemed less effective, particularly in improving knowledge of the correct dosage and duration of zinc treatment. Consistent supplies and sufficient attention to training all health care cadres, especially community health workers who may be new to diarrhea treatment and informal-sector providers who are typically excluded from formal training, are critical to improving knowledge and prescribing behaviors.
- Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda’s Southern Kayonza District
Community members and health workers recognized the value of spacing and limiting births but a variety of traditional and gender norms constrain their use of contraception. Limited method choice, persistent side effects, transportation fees, stock-outs, long wait times, and hidden service costs also inhibit contraceptive use.