Latest Articles
- mHealth for Tuberculosis Treatment Adherence: A Framework to Guide Ethical Planning, Implementation, and Evaluation
Promising mHealth approaches for TB treatment adherence include:
Video observation
Patient- or device-facilitated indirect monitoring
Direct monitoring through embedded sensors or metabolite testing
To mitigate ethical concerns, our framework considers accuracy of monitoring technologies, stigmatization and intrusiveness of the technologies, use of incentives, and the balance of individual and public good.
- 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.
- Handwashing With a Water-Efficient Tap and Low-Cost Foaming Soap: The Povu Poa “Cool Foam” System in Kenya
The new handwashing system, designed with end user input, features an economical foaming soap dispenser and a hygienic, water-efficient tap for use in household and institutional settings that lack reliable access to piped water. Cost of the soap and water needed for use is less than US$0.10 per 100 handwash uses, compared with US$0.20–$0.44 for conventional handwashing stations used in Kenya.
- Feasibility and Effectiveness of mHealth for Mobilizing Households for Indoor Residual Spraying to Prevent Malaria: A Case Study in Mali
Sending voice and/or text messages to mobilize households for spraying was more costly per structure and less effective at preparing structures than traditional door-to-door mobilization approaches supplemented with radio and town hall announcements. Challenges included:
Lack of familiarity with mobile phones and with public health mobile messaging
Lack of face-to-face communication with mobilizers, making it easier to ignore mobilization messages and preventing trust-building
Low literacy levels
Gender differentials in access to mobile phones
- Fertility Awareness Methods Are Not Modern Contraceptives: Defining Contraception to Reflect Our Priorities
A recent article in GHSP calls for classifying fertility awareness methods as “modern contraceptives” despite their inferiority. We believe in a rights-based approach, which considers the real-world conditions that many women face, including constrained sexual agency and low baseline reproductive health literacy. We must demonstrate true commitment to increasing access to the most effective and reliable contraceptive methods.
- Response to Austad: Offering a Range of Methods, Including Fertility Awareness Methods, Facilitates Method Choice
When selecting a contraceptive method, women and men consider various attributes in addition to effectiveness, such as side effects, return to fertility, level of medical intervention, and interference with sexual activity. Offering a range of methods, including fertility awareness methods that meet the standard to be considered modern, helps to address these considerations, facilitating method choice.
- 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.
- A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept
Use of the inserter was found to be safe, with high fundal placement in 82% of cases. Complete expulsion occurred in 7.5% of cases and partial expulsion was detected in 10%, comparable with rates in other studies using standard IUD insertion techniques. Further study and use of the dedicated inserter may reveal increased convenience and reduced risk of infection among users and could improve acceptability of postpartum IUD provision among providers.
- Social Entrepreneurship: A Case Study From Brazil
Through careful sourcing of commodities, cost-cutting efficiencies, and realistic pricing, 3 large contraceptive social marketing programs evolved into profit-making enterprises while continuing to make low-priced contraceptives available to low-income consumers on a substantial scale.