Subjects -> HEALTH AND SAFETY (Total: 1464 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (686 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (358 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (112 journals)
    - PHYSICAL FITNESS AND HYGIENE (117 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH AND SAFETY (686 journals)                  1 2 3 4 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 1)
ACM Transactions on Computing for Healthcare     Hybrid Journal  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 2)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11)
Advances in Public Health     Open Access   (Followers: 30)
Adversity and Resilience Science : Journal of Research and Practice     Hybrid Journal   (Followers: 3)
African Health Sciences     Open Access   (Followers: 7)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 3)
Ageing & Society     Hybrid Journal   (Followers: 40)
Aging and Health Research     Open Access   (Followers: 3)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 10)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
Akademika     Open Access  
American Journal of Family Therapy     Hybrid Journal   (Followers: 6)
American Journal of Health Economics     Full-text available via subscription   (Followers: 25)
American Journal of Health Education     Hybrid Journal   (Followers: 36)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Sciences     Open Access   (Followers: 11)
American Journal of Health Studies     Full-text available via subscription   (Followers: 14)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 34)
American Journal of Public Health     Full-text available via subscription   (Followers: 208)
American Journal of Public Health Research     Open Access   (Followers: 31)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 9)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 10)
Annals of Health Law     Open Access   (Followers: 7)
Applied Biosafety     Hybrid Journal   (Followers: 2)
Applied Ergonomics     Hybrid Journal   (Followers: 18)
Apuntes Universitarios     Open Access   (Followers: 1)
Archives of Community Medicine and Public Health     Open Access   (Followers: 2)
Archives of Medicine and Health Sciences     Open Access   (Followers: 5)
Archives of Suicide Research     Hybrid Journal   (Followers: 11)
Archivos de Prevención de Riesgos Laborales     Open Access  
ASA Monitor     Full-text available via subscription   (Followers: 18)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 7)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 4)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 11)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 5)
Asian Journal of Medicine and Health     Open Access   (Followers: 1)
Asian Journal of Population Sciences     Open Access   (Followers: 9)
Asian Journal of Social Health and Behavior     Open Access   (Followers: 3)
Atención Primaria     Open Access   (Followers: 2)
Atención Primaria Práctica     Open Access  
Australasian Journal of Paramedicine     Open Access   (Followers: 8)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 5)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 15)
Bijzijn XL     Hybrid Journal  
Biograph-I : Journal of Biostatistics and Demographic Dynamic     Open Access   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 7)
Biosafety and Health     Open Access  
Biosalud     Open Access  
Birat Journal of Health Sciences     Open Access  
BLDE University Journal of Health Sciences     Open Access   (Followers: 1)
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
Brazilian Journal of Medicine and Human Health     Open Access  
British Journal of Health Psychology     Hybrid Journal   (Followers: 52)
Buletin Penelitian Kesehatan     Open Access  
Buletin Penelitian Sistem Kesehatan     Open Access  
Cadernos de Educação, Saúde e Fisioterapia     Open Access  
Cadernos de Saúde     Open Access  
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 13)
Canadian Family Physician     Partially Free   (Followers: 14)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 16)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Hybrid Journal   (Followers: 26)
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 1)
Carta Comunitaria     Open Access  
Case Reports in Women's Health     Open Access   (Followers: 4)
CASUS : Revista de Investigación y Casos en Salud     Open Access  
Central Asian Journal of Global Health     Open Access   (Followers: 2)
CES Medicina     Open Access  
CES Salud Pública     Open Access  
Child and Adolescent Obesity     Open Access   (Followers: 3)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
Children     Open Access  
Chinese Journal of Physiology     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access   (Followers: 1)
Christian Journal for Global Health     Open Access   (Followers: 1)
Ciencia & Salud     Open Access  
Ciencia & Trabajo     Open Access  
Ciencia e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia y Salud     Open Access   (Followers: 1)
Ciencia, Tecnología y Salud     Open Access  
Cities & Health     Hybrid Journal   (Followers: 5)
Cleaner and Responsible Consumption     Open Access  
Clinical and Experimental Health Sciences     Open Access   (Followers: 1)
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
Clocks & Sleep     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
Community Health     Open Access   (Followers: 6)
Conflict and Health     Open Access   (Followers: 8)
Contact (CTC)     Open Access  
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
Cuaderno de investigaciones: semilleros andina     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 10)
Current Opinion in Environmental Science & Health     Hybrid Journal  
D Y Patil Journal of Health Sciences     Open Access   (Followers: 4)
Das österreichische Gesundheitswesen ÖKZ     Hybrid Journal  
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Design for Health     Hybrid Journal   (Followers: 1)
Digital Health     Open Access   (Followers: 11)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 12)
Discover Social Science and Health     Open Access   (Followers: 6)
Diversity and Equality in Health and Care     Open Access   (Followers: 10)
Diversity of Research in Health Journal     Open Access   (Followers: 1)
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Open Access   (Followers: 2)
Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi / Journal of Duzce University Health Sciences Institute     Open Access  
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 23)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 25)
EcoHealth     Hybrid Journal   (Followers: 5)
Education for Health     Open Access   (Followers: 9)
electronic Journal of Health Informatics     Open Access   (Followers: 7)
ElectronicHealthcare     Full-text available via subscription   (Followers: 2)
Emerging Trends in Drugs, Addictions, and Health     Open Access   (Followers: 1)
Ensaios e Ciência : Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 3)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 7)
EsSEX : Revista Científica     Open Access  
Estudios sociales : Revista de alimentación contemporánea y desarrollo regional     Open Access  
Ethics & Human Research     Hybrid Journal   (Followers: 4)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 7)
Ethiopian Journal of Health Development     Open Access   (Followers: 7)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 6)
Ethnicity & Health     Hybrid Journal   (Followers: 16)
Eurasian Journal of Health Technology Assessment     Open Access   (Followers: 1)
EUREKA : Health Sciences     Open Access  
European Journal of Health Communication     Open Access  
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 5)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 11)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Exploratory Research in Clinical and Social Pharmacy     Open Access  
Expressa Extensão     Open Access  
F&S Reports     Open Access  
Face à face     Open Access  
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Hybrid Journal   (Followers: 13)
Family Medicine and Community Health     Open Access   (Followers: 8)
Family Relations     Partially Free   (Followers: 11)
FASEB BioAdvances     Open Access  
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 3)
Finnish Journal of eHealth and eWelfare : Finjehew     Open Access  
Food and Public Health     Open Access   (Followers: 10)
Food Hydrocolloids for Health     Open Access  
Food Quality and Safety     Open Access   (Followers: 2)
Frontiers in Digital Health     Open Access   (Followers: 4)
Frontiers in Neuroergonomics     Open Access  
Frontiers in Public Health     Open Access   (Followers: 8)
Frontiers of Health Services Management     Partially Free   (Followers: 6)
Gaceta Sanitaria     Open Access   (Followers: 2)
Galen Medical Journal     Open Access  
Ganesha Journal     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geospatial Health     Open Access   (Followers: 1)
Gestão e Desenvolvimento     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 7)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Advances in Health and Medicine     Open Access  
Global Challenges     Open Access   (Followers: 2)
Global Health : Science and Practice     Open Access   (Followers: 7)
Global Health Annual Review     Open Access   (Followers: 2)
Global Health Innovation     Open Access   (Followers: 4)
Global Health Journal     Open Access   (Followers: 2)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 5)
Global Journal of Public Health     Open Access   (Followers: 16)
Global Medical & Health Communication     Open Access   (Followers: 1)
Global Mental Health     Open Access   (Followers: 13)
Global Reproductive Health     Open Access   (Followers: 1)
Global Security : Health, Science and Policy     Open Access   (Followers: 1)
Global Transitions     Open Access   (Followers: 1)
Global Transitions Proceedings     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 7)
Hacia la Promoción de la Salud     Open Access  
Hastane Öncesi Dergisi     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HCU Journal     Open Access  
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 22)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 19)
Health and Human Rights     Open Access   (Followers: 10)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 64)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 5)
Health Behavior Research     Open Access   (Followers: 2)
Health Care Analysis     Hybrid Journal   (Followers: 12)
Health Equity     Open Access   (Followers: 4)
Health Information : Jurnal Penelitian     Open Access  
Health Information Management Journal     Hybrid Journal   (Followers: 26)
Health Notions     Open Access  

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Journal Cover
Global Health : Science and Practice
Journal Prestige (SJR): 1.315
Citation Impact (citeScore): 2
Number of Followers: 7  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2169-575X - ISSN (Online) 2169-575X
Published by U.S. Agency for International Development Homepage  [1 journal]
  • Willingness to Pay for HIV Prevention Commodities Among Key Population
           Groups in Nigeria

    • Authors: Olawale Durosinmi-Etti; Emmanuel Kelechi Nwala, Funke Oki, Akudo Ikpeazu, Emmanuel Godwin, Paul Umoh, Arome Shaibu, Alex Ogundipe, Abiye Kalaiwo
      Abstract: ABSTRACTIntroduction:Key population (KP) groups, such as female sex workers and men who have sex with men, in Nigeria rely on free HIV prevention commodities, including pre-exposure prophylaxis (PrEP) and HIV self-testing (HIVST) kits, provided through foreign aid. We investigated the willingness of KP groups to use and pay for HIV prevention commodities to support improved sustainable HIV prevention programming.Methods:In 2020, we conducted a cross-sectional survey in 3 states with KP groups. The survey covered sociodemographic characteristics and willingness to use and pay for PrEP, HIVST, and condoms, and we used a bidding game iteration process to collect data on factors that influence willingness to use and pay for the commodities. We performed bivariate and multivariable regression analyses to explore factors that may determine willingness to pay and the maximum amount willing to pay.Results:Of the participants surveyed, 73% were willing to pay for PrEP services, 81% were willing to pay for HIVST, and 87% were willing to pay for condoms. Willingness to pay varied between the commodities and was associated with, among other variables: age, KP group, marital status, level of education, employment status, place of residence, average monthly income, and familiarity with the commodity in question.Conclusion:We demonstrate that KP groups are willing to pay for HIV prevention commodities, but there is a need to bridge the gap between the maximum amount they are willing to pay and retail prices. If prices are reduced, the willingness to pay may result in high consumption and positive returns for the private sector.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-21-00303
      Issue No: Vol. 10, No. 5 (2022)
       
  • Changes in Child Undernutrition and Overweight in India From 2006 to 2021:
           An Ecological Analysis of 36 States

    • Authors: Jithin Sam Varghese; Aashish Gupta, Rukshan Mehta, Aryeh D. Stein, Shivani A. Patel
      Abstract: ABSTRACTObjectives:We evaluated changes in priority indicators of child growth from 2006 to 2021 and examined the role of human development measures in these changes.Methods:We estimated cumulative and annualized changes in state- and district-level child growth indicators using 3 rounds of National Family Health Surveys (2005–2006, 2015–2016, 2019–2021) in 36 states. Outcomes included stunting, underweight, wasting, and overweight. Human development was measured using a principal components analysis of 9 ecological indicators. We contrasted expected versus observed changes in district-level growth outcomes between 2016 and 2021 based on changes in development indicators using 2-way Blinder Oaxaca decomposition.Results:From 2006 to 2021, the prevalence of stunting, underweight, and wasting decreased by 12.3, 10.3, and 0.7 percentage points, respectively, while the prevalence of overweight increased by 1.9 percentage points. The annualized rate of within-state change for stunting was lower from 2016 to 2021 compared with the 2006 to 2016 period, while the rate of change in overweight was higher. Simultaneously, all 9 human development indicators improved between 2006 and 2021. A unit increase between 2016 and 2021 in the human development score predicted a −5.1 percentage point (95% confidence interval=−5.8, −4.4) change in stunting, yet observed stunting declined by just -2.5 percentage points.Conclusions:From 2016 to 2021, population-level reduction in child stunting has slowed and the rise in child overweight has accelerated, relative to the 10 years preceding this period.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-21-00569
      Issue No: Vol. 10, No. 5 (2022)
       
  • Do Children With Congenital Zika Syndrome Have Cerebral Palsy'

    • Authors: Alessandra Carvalho; Egmar Longo, Cristiana Nascimento–Carvalho, Nayara Argollo, Katia Edni Coelho, Aline Sampaio, Carlos Brites, Rita Lucena
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-21-00575
      Issue No: Vol. 10, No. 5 (2022)
       
  • Community Health Workers Improve HIV Disclosure Among HIV-Affected Sexual
           Partners in Rural Uganda: A Quasi-Experimental Study

    • Authors: Zubair Lukyamuzi; Ruth Mirembe Nabisere, Rita Nakalega, Patience Atuhaire, Hajira Kataike, Bashir Ssuna, Mazen Baroudi, Flavia Matovu Kiweewa, Philippa Musoke, Lisa M. Butler
      Abstract: ABSTRACTBackground:We evaluated the efficacy of a community health worker (CHW)–led intervention in supporting disclosure among adults living with HIV in heterosexual relationships.Methods:We conducted a quasi-experimental study with 2 arms allocated by geographically determined clusters and adjusted for between-group differences among adults living with HIV in the greater Luwero region of Uganda who had never disclosed their status to their current primary sexual partners. Clusters were allocated to either a CHW-led intervention or a control arm. In both arms, participants were consecutively recruited. As opposed to receiving routine care for the control arm, participants in the intervention arm received additional CHW disclosure support. The overall follow-up was 6 months, and the primary outcome was disclosure to the sexual partner. Data were analyzed using a clustered modified Poisson regression model with robust standard errors to determine independent factors associated with disclosure.Results:Of the 245 participants who enrolled, 230 (93.9%) completed the study, and 112 (48.7%) of those were in the intervention arm. The median age was 30 (interquartile range=25–37) years, the majority were women (76.5%), and most (80%) did not know their partners’ HIV status at study entry. At the end of follow-up, the overall disclosure prevalence was 74.4% (95% confidence interval [CI]=68.2, 79.9) and participants in the intervention arm were 51% more likely to disclose compared to those in the control (adjusted relative ratio [aRR]=1.51; 95% CI=1.28, 1.77). Men were 24% (aRR=1.24; 95% CI=1.07, 1.44) more likely to disclose compared to women, and membership in an HIV/AIDS association increased disclosure by 18% (aRR=1.18; 95% CI=1.01, 1.39).Conclusion:CHW support improved disclosure among adults living with HIV in heterosexual relationships when compared to routine care. Therefore, CHW-led mechanisms may be utilized in increasing disclosure among adults living with HIV in heterosexual relationships in rural settings.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-21-00631
      Issue No: Vol. 10, No. 5 (2022)
       
  • Developing and Testing a Chatbot to Integrate HIV Education Into Family
           Planning Clinic Waiting Areas in Lusaka, Zambia

    • Authors: Eileen A. Yam; Edith Namukonda, Tracy McClair, Samir Souidi, Nachela Chelwa, Nelly Muntalima, Michael Mbizvo, Ben Bellows
      Abstract: ABSTRACTBackground:To maximize protection against both unintended pregnancy and HIV, it is important that family planning (FP) services integrate HIV counseling, both to support method choice and identify potential HIV services of interest, such as pre-exposure prophylaxis (PrEP). However, FP providers often lack sufficient time and knowledge to address HIV vulnerability with clients. To potentially offload some of the initial HIV counseling burden from FP providers, we developed and tested a chatbot that provided information about HIV and dual protection to FP clients in waiting areas of FP clinics in Lusaka, Zambia.Chatbot Development:We drafted a scripted conversation and tested it in English in formative workshops with Zambian women between the ages of 15 and 49 years. After translating the content to Bemba and Nyanja, we conducted a second round of workshops to validate the translations, before uploading the content into the chatbot platform.Chatbot User Test:Thirty volunteers tested the chatbot in 3 Lusaka FP clinics, completing an exit survey to provide feedback. A large majority (83%) said they learned new HIV information from the chatbot. Twenty (67%) learned about PrEP for the first time through the chat. Most (96%) reported discussing HIV with the provider, after engaging with the chatbot. In response to an open-ended question, several testers volunteered that they wanted to learn more about PrEP.Conclusions:Pre-consultation waiting-area time is an underutilized opportunity to impart HIV information to FP clients, thereby preparing them to discuss their dual HIV and pregnancy prevention needs when they see their providers. FP clients expressed particular interest in learning more about PrEP, underscoring the importance of integrating HIV into FP services.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-21-00721
      Issue No: Vol. 10, No. 5 (2022)
       
  • What Have We Learned' Implementation of a Shared Learning Agenda and
           Access Strategy for the Hormonal Intrauterine Device

    • Authors: Kate H. Rademacher; Tabitha Sripipatana, Kendal Danna, Deborah Sitrin, Aurelie Brunie, Katie M. Williams, Kayode Afolabi, Francia Rasoanirina, Saumya Ramarao, Anne Pfitzer, Devon Cain, Morgan Simon, Elaine Menotti, Anna Hazelwood, Anthony Adindu Nwala, Zainab Saidu, Raveena Chowdhury, Anne Taiwo, Agnes Chidanyika, Gathari Ndirangu, Markus J. Steiner, Marie Chantale Lepine, Rick Homan, Abdulmumin Saad, John Vivalo, Laneta J. Dorflinger
      Abstract: ABSTRACTIn 2015, a global learning agenda for the hormonal intrauterine device (IUD) was developed with priority research questions regarding use of the method in low- and middle-income countries. In addition, members of the Hormonal IUD Access Group aligned on a strategy to expand access in the context of volunteerism and contraceptive method choice. This article synthesizes evidence generated since then and describes steps taken to address demand- and supply-side barriers to access. Findings demonstrated high continuation rates and satisfaction among hormonal IUD users that are comparable to other long-acting reversible contraceptives (LARCs). Across studies, a sizable number of users reported they would have chosen a short-acting method or no method at all if the hormonal IUD were not an option, which suggests that women did not see the hormonal IUD as interchangeable with other LARC options and thus it may fill an important niche in the market. With several countries now poised to scale up the method, resource mobilization will be key. On the demand side, investments in implementation research will be critical to understanding how best to launch and scale the method, while ensuring the sustainability of multiple quality-assured suppliers with affordable public-sector pricing will be necessary on the supply side.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-21-00789
      Issue No: Vol. 10, No. 5 (2022)
       
  • Meeting the Sexual and Reproductive Health Needs of Internally Displaced
           Persons in Ethiopia’s Somali Region: A Qualitative Process Evaluation

    • Authors: Kathryn A. O’Connell; Tesfaye Shiferaw Hailegebriel, Danielle Garfinkel, Jenna Durham, Bereket Yakob, Jemal Kassaw, Addisalem Titiyos Kebede
      Abstract: ABSTRACTIntroduction:Meeting the sexual and reproductive health and rights (SRHR) needs of internally displaced persons (IDPs) is critical. Despite increased prioritization and coverage of sexual and reproductive health (SRH) services in humanitarian settings in recent decades, significant unmet needs remain. In Ethiopia, there are more than 2 million IDPs, an estimated 40% of whom have unmet need for modern contraceptives. To address this, EngenderHealth implemented a model of SRHR programming in Ethiopia’s Somali region. We share the lessons learned from this project to improve access to SRH services among IDPs.Methods:In 2021, an independent research team implemented a qualitative process evaluation among 13 key informant interviews (KIIs) with health system actors, local government partners, and organizations, and 4 focus group discussions (FGDs) with community members and community health volunteers. The team selected participants purposively following the maximum variation sampling technique and analyzed the data in NVivo 12. The team used KII and FGD guides to explore and understand what was implemented, which stakeholders were engaged in the processes and how, what was achieved, and the barriers and facilitators in implementation.Results:Contributions to project achievements included strong partnerships and stakeholder engagement, an enabling environment for SRHR, improving health worker capacity, and flexibility and adaptability. Challenges included a fragile security situation, retention of providers, and difficulty in accessing gender-based violence services, exacerbated by the coronavirus disease (COVID-19) pandemic.Conclusion:Our article offers guidance for organizations and government entities seeking to design and implement SRHR programs in humanitarian settings. Findings highlight the importance of prioritizing SRHR programming in IDP settings and illustrate adaptable activities to assist with project implementation and minimize operational challenges.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-21-00818
      Issue No: Vol. 10, No. 5 (2022)
       
  • Comprehensive Vaccine-Preventable Disease Surveillance in the Western
           Pacific Region: A Literature Review on Integration of Surveillance
           Functions, 2000-2021

    • Authors: Morgane Donadel; Heather M. Scobie, Roberta Pastore, Varȷa Grabovac, Nyambat Batmunkh, Stephanie O’Connor, Benȷamin A. Dahl, Christopher S. Murrill
      Abstract: ABSTRACTIntroduction:A strategic framework for 2021–2030 developed by the World Health Organization (WHO) Regional Office for the Western Pacific emphasizes the need for high-quality and integrated vaccine-preventable disease (VPD) surveillance. We conducted a literature review to document the barriers, enabling factors, and innovations for integrating surveillance functions for VPDs and other communicable diseases in Western Pacific Region (WPR) countries.Methods:We searched published and gray literature on integrated VPD surveillance from 2000 to 2021. Articles in English, Spanish, or French were screened to identify those relating to VPD surveillance in a WPR country and not meeting defined exclusion criteria. We categorized articles using the 8 WHO surveillance support functions and abstracted data on the country; type of surveillance; and reported barriers, enabling factors, and best practices for integration.Results:Of the 3,137 references screened, 87 met the eligibility criteria. Of the 8 surveillance support functions, the proportion of references that reported integration related to the laboratory was 56%, followed by workforce capacity (54%), governance (51%), data management and use (47%), field logistics and communication (47%), coordination (15%), program management (13%), and supervision (9%). Several references noted fragmented systems and a lack of coordination between units as barriers to integration, highlighting the importance of engagement across public health units and between the public and private sectors. The literature also indicated a need for interoperable information systems and revealed the use of promising new technologies for data reporting and laboratory testing. In some WPR countries, workforce capacity was strengthened at all administrative levels by the implementation of integrated trainings on data monitoring and use and on laboratory techniques applicable to multiple VPDs.Conclusion:This literature review supports integrating VPDs into broader communicable disease surveillance systems in WPR countries while ensuring that the minimal WHO-recommended standards for VPD surveillance are met.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00017
      Issue No: Vol. 10, No. 5 (2022)
       
  • Early Reflections on Mphatlalatsane, a Maternal and Neonatal Quality
           Improvement Initiative Implemented During COVID-19 in South Africa

    • Authors: Willem Odendaal; Ameena Goga, Terusha Chetty, Helen Schneider, Yogan Pillay, Carol Marshall, Ute Feucht, Tsakane Hlongwane, Shuaib Kauchali, Manala Makua
      Abstract: ABSTRACTDespite global progress in reducing maternal and neonatal mortality and stillbirths, much work remains to be done to achieve the Sustainable Development Goals. Reports indicate that coronavirus disease (COVID-19) disrupts the provision and uptake of routine maternal and neonatal health care (MNH) services and negatively impacts cumulative pre-COVID-19 achievements. We describe a multipartnered MNH quality improvement (QI) initiative called Mphatlalatsane, which was implemented in South Africa before and during the COVID-19 pandemic. The initiative aimed to reduce the maternal mortality ratio, neonatal mortality rate, and stillbirth rate by 50% between 2018 and 2022. The multifaceted design comprises QI and other intervention activities across micro-, meso-, and macrolevels, and its area-based approach facilitates patients’ access to MNH services. The initiative commenced 6 months pre-COVID-19, with subsequent adaptation necessitated by COVID-19. The initial focus on a plan-do-study-act QI model shifted toward meeting the immediate needs of health care workers (HCWs), the health system, and health care managers arising from COVID-19. Examples include providing emotional support to staff and streamlining supply chain management for infection control and personal protection materials. As these needs were addressed, Mphatlalatsane gradually refocused HCWs’ and managers’ attention to recognize the disruptions caused by COVID-19 to routine MNH services. This gradual reprioritization included the development of a risk matrix to help staff and managers identify specific risks to service provision and uptake and develop mitigating measures. Through this approach, Mphatlalatsane led to an optimization case using existing resources rather than requesting new resources to build an investment case, with a responsive design and implementation approach as the cornerstone of the initiative. Further, Mphatlalatsane demonstrates that agile and context-specific responses to crises such as the COVID-19 pandemic can mitigate such threats and maintain interventions to improve MNH services.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00022
      Issue No: Vol. 10, No. 5 (2022)
       
  • Designing for Impact and Institutionalization: Applying Systems Thinking
           to Sustainable Postpartum Family Planning Approaches for First-Time
           Mothers in Bangladesh

    • Authors: Melanie Yahner; Angela Muriuki, Amy Mangieri, Syeda Nabin Ara Nitu, Shumona Shafinaz, Eric Sarriot
      Abstract: ABSTRACTIntegrated service delivery approaches have shown promise to increase use of services including postpartum family planning (PPFP) by young, first-time mothers (FTMs) but have proven challenging to scale and institutionalize. Integration adds complexity, requiring careful assessment of effects on a range of key system functions from demand creation and service delivery to oversight and governance. Through an innovative design process, we selected approaches to increase FTMs’ PPFP use through existing health systems. We generated programmatic options and then sought to select approaches based on (1) potential impact on FTMs’ PPFP uptake and (2) potential to institutionalize in the health system. The latter represented an innovation in addressing management systems’ drivers of scalability and sustainability; to accomplish it, we developed a participatory design process to assess the potential of an approach to be institutionalized in a specific context.We adapted a management systems theory, the Viable System Model (VSM), which presents 5 essential organizational functions and the relations required between them to improve the viability (performance and institutionalization) of organizational systems. Drawing from the VSM, we developed a process for reviewing the effects of proposed approaches on provider workload, client flow, infrastructure, revisions to guidelines and job descriptions, coordination and management, and information systems. The VSM provided a structure to identify potential displacement of capacity in the health system and mitigate often neglected organizational challenges that compromise institutionalization. The process informed the elimination of approaches with potential for impact but that had deal-breakers to institutionalization, such as increased workload or shifted job descriptions, in the Bangladeshi context. For the selected approaches, consideration of systems elements fostered discussion of expected risks to institutionalization, highlighting needed mitigation efforts and monitoring during implementation.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00023
      Issue No: Vol. 10, No. 5 (2022)
       
  • Qualitative Examination of the Role and Influence of Mothers-in-Law on
           Young Married Couples’ Family Planning in Rural Maharashtra, India

    • Authors: Anvita Dixit; Mohan Ghule, Namratha Rao, Madhusudana Battala, Shahina Begum, Nicole E. Johns, Sarah Averbach, Anita Raj
      Abstract: ABSTRACTUnmet need for family planning (FP) continues to be high in India, especially among young and newly married women. Mothers-in-law (MILs) often exert pressure on couples for fertility and control decision making and behaviors around fertility and FP, yet there is a paucity of literature to understand their perspectives. Ten focus group discussions (FGDs) were carried out with MILs of young married women (aged 18–29 years) participating in a couple-focused FP intervention as a part of a cluster-randomized intervention evaluation trial (the CHARM2 study) in rural Maharashtra, India. FGDs included questions on their roles, attitudes, and decision making around fertility and FP. Audio-recorded data were translated/transcribed into English and analyzed for key themes using a deductive coding method. MILs reported having social norms of early fertility and son preference. They understood that family size norms are lower among daughters-in-law and that spacing can be beneficial but were not supportive of short-term contraceptives, especially before the first child. They preferred female sterilization, opposed abortion, had apprehensions around side effects from contraceptive use, and had misconceptions about the intrauterine device, with particular concerns around its coercive insertion. MILs mostly believed that decision making should be done jointly by a husband and wife, but that as elders, they should be consulted and involved in the decision-making process. These findings highlight the need for engagement of MILs for FP promotion in rural India and the potential utility of social norms interventions.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00050
      Issue No: Vol. 10, No. 5 (2022)
       
  • Financial Implications of Tariffs for Medical Oxygen on Rwandan Public
           Hospitals’ Finance Management During the Coronavirus Epidemic

    • Authors: Diana Kizza; Hyacinth Mushumbamwiza, Siyabonga Ndwandwe, Moyo Butholenkosi, Regis Hitimana, Damien Kirchoffer, Jason Houdek, Eoghan Brady, Logan Brenzel, Nathalie Umutoni, Donatien Bajyanama, Zuberi Muvunyi
      Abstract: ABSTRACTIn Rwanda, provider reimbursements for oxygen are based on the duration of patient consumption at a fixed hourly tariff rate. This study sought to assess whether the current insurance tariff in Rwanda was adequate to cover the costs of oxygen used in oxygen therapy and to explore alternative tariff models.The assessment found that hospitals make a marginal surplus from low volume flow rate patients and incur losses from patients who require high volume flow rates. In high volume nonspecialized hospitals with a large pool of patients consuming medical oxygen, low flow rate usage patients (e.g., neonates) tend to subsidize high flow usage patients (surgery), if the number of patients consuming low flow oxygen is higher than the latter. The study found that the current tariff was sufficient before the exponential surge in demand for high flow usage during the peak of the COVID-19 pandemic. A variable tariff that factors both the duration (hours) and the volume (liters) used during the therapy may require more work but better reflects the cost of consumption in each ward. A case-based payment model provides a standard pricing framework based on the patient’s diagnosis, intervention, and intensity of treatment.This study highlights the need for a transition from the time-based tariff structure to a case-based or volume-based tariff to incentivize sustainable production and provision (supply) of medical oxygen services at health facilities in Rwanda. Social health insurance reimbursement tariffs for medical oxygen need to reflect both duration and volume of consumption because oxygen therapy varies based on intervention, disease severity, patient age, length of stay, and responsiveness to treatment.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00058
      Issue No: Vol. 10, No. 5 (2022)
       
  • A Tale of 2 Countries: Implementation of the Cold Chain Equipment
           Optimization Platform in Guinea and Kenya

    • Authors: Emily Stammer; Lea Teklemariam, Aliou Barry, Roger Millimono, Amos Chweya, Nicole Danfakha, Caddi Golia, Elena Herrera, Leslie Patykewich, Wendy Prosser, Soumya Alva
      Abstract: ABSTRACTIn 2016, the Gavi Cold Chain Equipment Optimization Platform (CCEOP) was approved and launched in recognition of the fact that functional cold chain equipment (CCE) is essential to strengthening vaccine supply chains and ultimately achieving Gavi’s immunization equity and coverage goals. Through CCEOP, Gavi committed to investing US$250 million between 2016 and 2021 to commission CCE in more than 63,000 facilities to upgrade and expand their CCE footprint while stimulating the market to provide affordable, technologically advanced, and accessible equipment. We present case studies from Guinea and Kenya, both of which received CCEOP support, that highlight 2 ways for countries to prioritize investments and implement activities through a large funding and support mechanism. The studies explore the different ways that each country implemented CCEOP and consider how aspects of leadership and technical capacity influence country priorities and results. They also uncover key lessons on sustainability of a large immunization supply chain effort. The experiences of Guinea and Kenya can help other countries embarking on similarly large health system interventions, especially related to supply chain strengthening and immunization programs. In particular, these experiences offer important lessons in leadership, processes and systems, country ownership, technical capacity, and sustainability.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00066
      Issue No: Vol. 10, No. 5 (2022)
       
  • Digital Health Technologies Applied by the Pharmaceutical Industry to
           Improve Access to Noncommunicable Disease Care in Low- and Middle-Income
           Countries

    • Authors: Anne Christine Stender Heerdegen; Carlotta Maria Cellini, Veronika J. Wirtz, Peter C. Rockers
      Abstract: ABSTRACTBackground:There is limited research on how digital health technologies (DHTs) are used to promote access to care for patients with noncommunicable diseases (NCDs), particularly in low- and middle-income countries (LMICs). We describe the use of DHTs in pharmaceutical industry–led access programs aimed at improving access to NCD care in LMICs.Methods:The Access Observatory is the largest publicly available repository containing detailed information about pharmaceutical industry—led access programs targeting NCDs. The repository includes 101 access program reports submitted by 19 pharmaceutical companies. From each report, we extracted data relating to geographic location, disease area, beneficiary population, use of DHTs, partnerships, strategies, and activities. Data were analyzed descriptively using SAS Statistical Software and categorized according to the World Health Organization Digital Health Classification Framework.Results:A total of 43 access programs (42.6%) included DHTs. The majority of programs using DHTs were clustered across sub-Saharan Africa (72.1%) and targeted cancer (60.5%) followed by metabolic disorders (39.5%). The applied DHTs mostly related to program strategies on health service strengthening (74.4%) and community awareness (41.9%) and were largely directed toward health providers, followed by data services and clients. Only a few DHTs were used for health system management. To promote access, most DHTs focused on improving data collection, management, and use (51.1%); building health provider capacity through training (37.2%); and providing targeted patient information (34.8%).Conclusion:The range of DHTs applied by the pharmaceutical industry offers opportunities for more effective access to NCD care. Transparent reporting on DHT use and its contributions to access programs’ achievements may reduce duplicative and redundant efforts and provide learnings for private and public stakeholders that may contribute to greater access to NCD care in LMICs.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00072
      Issue No: Vol. 10, No. 5 (2022)
       
  • Improving the Quality of Health Care in Special Neonatal Care Units of
           India: A Before and After Intervention Study

    • Authors: Ashok K. Deorari; Praveen Kumar, Deepak Chawla, Anu Thukral, Sonika Goel, Rajashree Bajaj, Manish Singh, Clare Gilbert, Rajan Shukla, for the Retinopathy of Prematurity-Quality Improvement India Study Group
      Abstract: ABSTRACTBackground:We evaluated the efficacy of training health care workers (HCWs) in point-of-care quality improvement (POCQI) and a preterm newborn health care package (PHCP), followed by remote mentoring and supportive supervision in improving health care practices, neonatal survival, and morbidities in special neonatal care units (SNCUs).Methods:This pre- and postintervention quality improvement study was conducted at 3 SNCUs in Madhya Pradesh, India from February 2017 to February 2019. Clinical care teams comprising doctors and nurses from the study sites were trained in POCQI and the PHCP. The teams identified, prioritized, and analyzed problems and designed quality improvement initiatives at their respective health facilities. Change ideas were tested by the local teams using sequential plan-do-study-act cycles. Facilitators maintained contact with the teams through quarterly review meetings, fortnightly videoconferencing, on-demand phone calls, and group chat service. State SNCU coordinators made follow-up visits to supplement coaching. Study research staff independently collected data on admissions, health care practices, and outcomes of neonates.Findings:A total of 156 HCWs were trained in the POCQI methodology and PHCP. Sixteen quality improvement projects were formulated and implemented. Among 13,821 enrolled neonates (birth weight 2275±635 g; gestation: 35.8±2.8 weeks), improvement was seen in reduction of use of oxygen (36.1% vs. 48.0%; adjusted odds ratio [aOR]=0.60, 95% confidence interval [CI]=0.55, 0.66), antibiotics (29.4% vs. 39.0%; aOR=0.76, 95% CI=0.68, 0.85), and dairy milk (33.8% vs. 49.4%; aOR=0.34, 95% CI=0.31 to 0.38). Enteral feeds were started within 24 hours of admission in a larger number of neonates, resulting in fewer days to reach full feeds. There was no effect on survival at discharge from the hospital (aOR=0.93; 95% CI=0.80, 1.09).Conclusion:A collaborative cross-learning quality improvement approach with remote mentoring, coaching, and supportive supervision was successful in improving the quality of care at SNCUs.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00085
      Issue No: Vol. 10, No. 5 (2022)
       
  • Multisectoral, Combination HIV Prevention for Adolescent Girls and Young
           Women: A Qualitative Study of the DREAMS Implementation Trajectory in
           Zambia

    • Authors: Joseph G. Rosen; Maurice Musheke, Drosin Mulenga, Edith S. Namukonda, Nrupa Jani, Michael T. Mbizvo, Julie Pulerwitz, Sanyukta Mathur
      Abstract: ABSTRACTObjective:To identify solutions to the implementation challenges with the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women) Partnership in Zambia, this study examines the rollout and evolution of the DREAMS Partnership’s implementation.Methods:In September–October 2018, implementing partner (IP) staff (n=15) and adolescent girls and young women (AGYW) participating in DREAMS programming (n=32) completed in-depth interviews exploring early rollout and scale-up of DREAMS, experiences with program participation, and shifting service delivery approaches in response to emerging implementation challenges. Inductive and deductive thematic analysis of 47 interviews uncovered salient service delivery facilitators and barriers in the first 2 years of DREAMS implementation, which were subsequently mapped onto the following domains: reach, effectiveness, adoption, implementation, and maintenance.Results:Key implementation successes identified by IP staff included using standardized recruitment and risk assessment tools across IP organizations, using a mentor model for delivering program content to AGYW, and offering centralized service delivery at venues accessible to AGYW. Implementation challenges identified early in the DREAMS Partnership’s lifecycle were rectified through adaptive service delivery strategies. Monthly in-person coordination meetings were established to resolve IP staff jurisdictional disputes over recruitment and target setting. To address high participant attrition, IP staff adopted a cohort approach to sequentially recruit AGYW who enrolled together and provided social support to one another to sustain involvement in DREAMS programming. Prominent barriers to implementation fidelity included challenges recruiting the highest-risk AGYW (e.g., those out of school), limited resources to incentivize participation by young women, and inadequate planning to facilitate absorption of individual DREAMS interventions by the public sector upon project conclusion.Conclusions:Delivering multisectoral HIV prevention programs like DREAMS with fidelity requires a robust implementation infrastructure (e.g., adaptable workplans and harmonized record management systems), early coordination between IP organizations, and sustained financial commitments from donors.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00089
      Issue No: Vol. 10, No. 5 (2022)
       
  • Crossing the Last Mile of TB Care in Rural Southern Madagascar: A
           Multistakeholder Initiative

    • Authors: Nadine Muller; Fierenantsoa Ranȷaharinony, Miandrisoa Etrahagnane, Anna Fruhauf, Turibio Razafindranaivo, Hortensia Ramasimanana, Julius Valentin Emmrich
      Abstract: ABSTRACTDespite a free TB care policy, access to TB care in rural Madagascar is limited due to a markedly underfunded health care system. The World Health Organization estimated the yearly TB incidence in Madagascar at 238 cases per 100,000 people in 2020; only half of the patients with TB are being notified and treated. We describe the development, implementation, and lessons learned of an intervention to improve TB care services in a remote, rural district in southern Madagascar. We involved national, regional, and local stakeholders in assessing the multifaceted challenges in a remote, rural area and codesigning activities to address them. The overarching principles of the intervention were to (1) promote national TB guidelines, (2) build on best practices, and (3) prioritize low-cost activities to enable scale-up. An in-depth assessment of challenges in accessing and delivering TB care resulted in the following prioritization of activities: (1) fostering community engagement, (2) decentralizing service provision, (3) improving quality of care, (4) providing nutritional support, and (5) ensuring staff support and supervision. The intervention was launched in September 2019 and is ongoing as of October 2022. During mobile TB clinics conducted between September 2019 and December 2020, 4,982 presumptive patients were screened and 1,706 (34.2%) have been diagnosed with TB. Based on 2010–2020 official TB notification data, we calculated trend-adjusted additional TB notifications during the intervention, resulting in a 2.6-fold increase in cases in 2019–2020. The intervention district’s TB notification rate increased from 178 cases per 100,000 people in 2018 to 424 cases per 100,000 people in 2020. Involving stakeholders from all levels of care was perceived as a key to success. The unexpected increase in the number of patients with TB in the intervention district overburdened the current paper-based TB notification system and emphasized the need for expanded diagnostics and social support services.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00101
      Issue No: Vol. 10, No. 5 (2022)
       
  • Making Removals Part of Informed Choice: A Mixed-Method Study of Client
           Experiences With Removal of Long-Acting Reversible Contraceptives in
           Senegal

    • Authors: Aurelie Brunie; Fatou Ndiate Rachel Sarr Aw, Salif Ndiaye, Etienne Dioh, Elena Lebetkin, Megan M. Lydon, Elizabeth Knippler, Sarah Brittingham, Mareme Dabo, Mareme Mady Dia Ndiaye
      Abstract: ABSTRACTBackground:Ensuring access to removal services for implants and intrauterine devices (IUDs) is essential to realize informed choice and voluntary family planning. We document removal desires and experiences among women who received an implant or IUD from the public sector in 3 districts of Senegal.Methods:We conducted a phone survey of 1,868 implant and IUD users, 598 follow-up surveys with those who had ever asked a provider for a removal, and 24 in-depth interviews (IDIs) with women who had ever wanted an implant removal. We analyzed survey data descriptively and IDI data thematically.Results:Fifty-eight percent of implant users and 54% of IUD users reported having wanted a removal. Desired pregnancy and contraceptive-induced menstrual changes (CIMCs) were the main reasons for removal desires. Fifty-four percent of implant users and 55% of IUD users who asked a provider for a removal reported challenges accessing services, with over two-thirds noting long lines or wait times. Sixty-three percent of implant users and 73% of IUD users who saw a provider were satisfied with the outcome of their first interaction. Over 90% of participants had not been told about the removal cost at insertion. Almost all participants who had their method removed obtained a complete removal during their first clinical procedure. Around two-thirds of participants who obtained a removal did not take up another method at that time. IDIs confirmed the influence of CIMCs on removal desires and show some partner influence is common in removal decision making. Barriers include lack of available qualified providers and supplies. Provider interactions play an important role in satisfaction with removal services.Conclusion:Participants’ experiences accessing removal services were generally positive. Areas of potential improvement include client flow, counseling messages at insertion, and when advising clients to keep their method, pricing, and post-removal reinsertion or method switching.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00123
      Issue No: Vol. 10, No. 5 (2022)
       
  • Lessons Learned From Integrating Infant and Young Child Feeding Counseling
           and Iron-Folic Acid Distribution Into Routine Immunization Services in
           Ethiopia

    • Authors: Natasha Kanagat; Adriana Alminana, Belayneh Dagnew, Lisa Oot, Amare Bayeh, Daniel Girma, Getu Molla Tarekegn, Yohannes Lakew Tefera, Meseret Zelalem Tadesse, Hiwot Darsene Dimd, Zenaw Adam
      Abstract: ABSTRACTImmunization programs reach more children and communities than any other health intervention, thus making immunization a promising platform for integrating other essential health services. There is a dearth of literature on integrating nutrition interventions, such as infant and young child feeding (IYCF) counseling and iron-folic acid (IFA) supplementation, into routine immunization services.To address this evidence gap, a 15-month pilot study (August 2019 to November 2020) tested the feasibility of integrating IYCF counseling and IFA supplement distribution into immunization service delivery in Ethiopia. The interventions focused on joint microplanning for integrated services (including estimating target populations for all services), revising client flows for service delivery, and providing on-the-job support to HWs for implementing and monitoring integrated service delivery.Findings suggest that planning for and delivering IYCF counseling and IFA supplementation with immunization services is feasible. Integrating these services provided opportunities for collaborative planning and enabled health workers (HWs) to offer multiple services to clients through 1 interaction. However, HWs felt that additional human resources were needed to manage integrated services, especially during integrated outreach and mobile service delivery. HWs also reported that communities appreciated accessing 2 services in 1 visit but expressed reservations about the longer wait times.Countries may consider expanding fixed and outreach immunization services to provide integrated service delivery provided that it is feasible, sustainable, of high quality, and incorporates the careful planning, follow-up, and increased human and financial resources needed to reinforce new practices and expand access to a broader array of health services.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00166
      Issue No: Vol. 10, No. 5 (2022)
       
  • Community Health Worker Program Outcomes for Diabetes and Hypertension
           Control in West Bank Refugee Camps: A Retrospective Matched Cohort Study

    • Authors: Asmaa Rimawi; Adarsh Shah, Henry Louis, David Scales, Jawad Abu Kheiran, Nashat Jawabreh, Sofia Yunez, Masako Horino, Akihiro Seita, Bram Wispelwey
      Abstract: ABSTRACTIntroduction:Community health worker (CHW) programs have proven effective in improving diabetes control in many locations and settings, but data on feasibility and efficacy are lacking in the Middle East and settings of chronic violence. A Palestinian CHW program, Health for Palestine (H4P), addresses chronic diseases in West Bank refugee camps. Our study assesses the feasibility and effectiveness of the program’s diabetes and hypertension interventions.Methods:Data on home visits, patient retention, and blood pressure were extracted from the CHW records and analyzed. To assess diabetic patient progress, we conducted a retrospective matched cohort study using data obtained from a United Nations (UN) clinical database to analyze the trajectory of hemoglobin A1c (A1c) values. Thirty of the 47 diabetic patients in the H4P CHW program met study inclusion criteria and were each matched with 3 patients from the Bethlehem UN clinic (n=120). We tested for significance using multivariable linear regression with robust standard errors.Results:The average number of home visits per patient per month was 7.3 (standard deviation=4.1), and the patient retention rate was 100% over an average of 11.2 months. For hypertension patients in the CHW program (n=33), mean systolic blood pressure decreased by 7.3 mmHg (95% confidence interval [CI]=1.93, 12.25; P=.009) and mean diastolic blood pressure by 4.3 mmHg (95% CI=0.80, 7.91; P=.018) from March 2018 to November 2019. On average, diabetic patients within the CHW group experienced a 1.4 point greater decline in A1c per year compared to those in the non-CHW group, after adjusting for potential confounders (95% CI=−0.66, −2.1; P
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00168
      Issue No: Vol. 10, No. 5 (2022)
       
  • Bottlenecks and Solutions During Implementation of the DREAMS Program for
           Adolescent Girls and Young Women in Namibia

    • Authors: Ellen W. MacLachlan; Abigail K. Korn, Alison L. Ensminger, Sharon Zambwe, Theopolina Kueyo, Rosanne Kahuure, Gena Barnabee, Josua Nghipangelwa, Juliet Mudabeti, Prisca Tambo, Agnes Mwilima, Elizabeth Muremi, Norbert Forster, Christa Fischer–Walker, Gabrielle O’Malley
      Abstract: ABSTRACTBackground:We synthesize implementation bottlenecks experienced while implementing the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) program, an HIV prevention intervention for adolescent girls and young women (AGYW), in Namibia from 2017 to 2019. Bottlenecks were organized into the following 4 AGYW program components.Program Access:Enrollment was slowed by the time-intensive nature of screening and other baseline data collection requirements, delays in acquiring parental consent, and limited time for after-school activities. Solutions included obtaining advance consent and providing 1-stop service delivery and transportation assistance.Health Education:We experienced difficulty identifying safe spaces for AGYW to meet. A lack of tailored curricula also impeded activities. Governments, stakeholders, and partners can plan ahead to help DREAMS identify appropriate safe spaces. Curricula should be identified and adapted before implementation.Health Services:Uneven availability of government-provided commodities (e.g., condoms, preexposure prophylaxis [PrEP], family planning products) and lack of AGYW-centered PrEP delivery approaches impacted services. Better forecasting of commodity needs and government commitment to supply chain strengthening will help ensure adequate program stock.Social Services:The availability of only centralized care following gender-based violence (GBV) and the limited number of government social workers to manage GBV cases constrained service provision. Triaging GBV cases—i.e., referring high-risk cases to government social workers and providing DREAMS-specific social services for other cases—can ensure proper caseload management.Conclusion:These bottlenecks highlight practical implementation issues and higher-level considerations for AGYW-centered HIV prevention programs. The critical need for multilayered programming for HIV/GBV prevention in AGYW cannot be addressed simply with additional funds but requires multilevel collaboration and forecasting. The urgency to achieve results must be balanced with the need for adequate implementation preparedness.
      PubDate: 2022-10-31T16:23:07-07:00
      DOI: 10.9745/GHSP-D-22-00226
      Issue No: Vol. 10, No. 5 (2022)
       
 
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