Latest Articles
- Policy and programmatic considerations for introducing a longer-acting injectable contraceptive: perspectives of stakeholders from Kenya and Rwanda
Unique attributes of a longer-acting injectable would likely appeal to both existing injectable users and new clients, both for spacing and for limiting births, and allow health systems to operate more efficiently. Considerations for enhancing successful introduction of this potential new method include keeping the cost low, expanding access through community-based distribution, and training providers to improve practices about injectables in general.
- Caution on corticosteroids for preterm delivery: learning from missteps
An important new study in lower-level health facilities in low- and middle-income countries found an increased risk of neonatal deaths with corticosteroid use in pregnant women with imminent preterm birth, in contrast with the positive results previously found in high-income countries. The surprising finding demonstrates that context matters. The increase appears largely due to steroids administered in cases that were not actually preterm, probably due to inaccurate pregnancy dating and challenges with diagnostic capacity. Promoting public health often requires decisions based on less-than-perfect evidence, but we must be vigilant about gathering and assessing new evidence and ready to change strategies.
- Maternal mental health in Amhara region, Ethiopia: a cross-sectional survey
Poor mental health, including suicidal thoughts, affects a substantial proportion of surveyed women who are up to 2 years postpartum in the Amhara region of Ethiopia. Opportunities for integrating basic psychosocial mental health services into maternal and child health services should be explored.
- Development and use of a master health facility list: Haiti's experience during the 2010 earthquake response
Collaboration between the Haitian government and NGOs after the 2010 earthquake contributed to a more accurate and complete master health facility list, which helped coordinate emergency response operations as well as strengthen the routine health information system. Open data and social networks facilitated the collection and sharing of health facility information and in maintenance of the list over time.
- Can traditional birth attendants be trained to accurately identify septic infants, initiate antibiotics, and refer in a rural African setting?
Despite having limited training, these TBAs were able to accurately identify critically ill neonates, initiate treatment in the field, and refer for further care. Given their proximity to the mother/infant pair, and their role in rural communities, training and equipping TBAs in this role could be effective in reducing neonatal mortality.
- Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation
During national scale up of iCCM in Rwanda, greater improvements in care-seeking were found in the districts where Kabeho Mwana implemented its model than in the rest of the country. Success was attributed to an emphasis on routine data review, intensive monitoring, collaborative supervision, community mobilization, and, in particular, CHW peer support groups.
- Evidence-based public health: not only whether it works, but how it can be made to work practicably at scale
Because public health must operate at scale in widely diverse, complex situations, randomized controlled trials (RCTs) have limited utility for public health. Other methodologies are needed. A key conceptual backbone is a detailed “theory of change” to apply appropriate evidence for each operational component. Synthesizing patterns of findings across multiple methodologies provides key insights. Programs operating successfully across a variety of settings can provide some of the best evidence. Challenges include judging the quality of such evidence and assisting programs to apply it. WHO and others should shift emphasis from RCTs to more relevant evidence when assessing public health issues.
- Major challenges to scale up of visual inspection-based cervical cancer prevention programs: the experience of Guatemalan NGOs
Scale up of visual inspection with acetic acid (VIA) in Guatemala encountered major challenges, including high attrition of people trained, didactic training without hands-on skills building, lack of continued supervision, and provision of VIA alone without immediate on-site provision of cryotherapy.
- Exclusive breastfeeding: aligning the indicator with the goal
While the global objective is exclusive breastfeeding (EBF) for a full 6 months duration, the standard indicator is a “prevalence” indicator, that is, the percentage of all children under age 6 months who are exclusively breastfed at a point in time. That yields a higher percentage than a more direct indicator of duration and can be easily misunderstood, exaggerating the amount of EBF. A measurement of actual percentage of children exclusively breastfeeding for a full 6 months can be easily calculated from standard DHS and MICS data.