Abstract
Sustainability of a congregation-based intervention to increase uptake of HIV testing and linkage to care in pregnant women in Nigeria (The Baby Shower Trial)
Juliet Iwelunmor, PhD1, John Ehiri, PhD, MPH, MSc2, Theddus Iheanacho, MBBS, DTM&H3, Micheal Obiefune, MD4, Ucheoma Nwaozuru, MS5, Dina Patel, MSN6 and Echezona Ezeanolue, MD, MPH7
(1)University of Illinois at Urbana Chamapaign, Champaign, IL, (2)University of Arizona, Mel & Enid Zuckerman College of Public Health, Tucson, AZ, (3)Yale School of Medicine, New Haven, (4)Sunrise Foundation, Enugu, Nigeria, (5)University of Illinois Urbana Champaign, Champaign, IL, (6)University of Nevada School of Medicine, Las Vegas, NV, (7)University of Nevada Las Vegas, Las Vegas, NV
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
There is probably no area in maternal and child health where the need to assure program sustainability is more critically needed than in efforts to prevent mother-to-child transmission of HIV/AIDS (PMTCT). The statistics are worrisome in countries like Nigeria. According to data from the UNAIDS, Nigeria remains one of 21 Global Plan priority countries in Africa that, with India, account for 90% of pregnant women infected with HIV globally. With the exception of few studies, evidence-based implementations of interventions to address PMTCT in Nigeria are limited. Furthermore, sustainability, an important stage in the overall life cycle of an implementation, has received remarkably little critical attention. This study explores what happened, over the longer term, after the initial funding of a congregation-based intervention-The Healthy Beginning Initiative (HBI), designed to increase the uptake of HIV testing and linkage to care in pregnant women living in southeast Nigeria, ended. Shediac-Rizkallah and Bone's framework for conceptualizing sustainability was used as a theoretical framework. We conducted in-depth interviews with 58 key staff (i.e. church-based health advisors (CHAs)) within select HBI sites, and with health care professionals responsible for HBI data collection at the church sites. We also conducted focus groups with 83 HBI participants from these sites to understand their views and experiences with the intervention and continuation of its program activities. Other data sources included observations of team meetings, documentary evidence such as study protocol and strategies, training strategy documents, and annual reports. The findings highlights aspects of the intervention design and implementation characteristics (such as intervention effectiveness) as well as factors at the organizational setting (i.e. institutional strength, fit, and program champions), and the broader community level (i.e. community dialogues) that influenced the likelihood of sustainability. Examining HBI's experience in detail illuminates how multilevel factors shape the sustainability of evidence-based interventions implemented in settings like Nigeria where nearly a third of HIV-infected women still do not start antiretroviral therapy (ART) during pregnancy. Funders, policymakers, and researchers may find the study results useful in understanding “what happens after the initial funding for new PMTCT programs expires?”
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
Predictors of Modern Contraceptive Use Among African Women
Ibitola Asaolu, DrPh, MPH1, Heather Dreifuss, MAT, MPH1, Jennifer Ehiri1 and John Ehiri, PhD, MPH, MSc2
(1)University of Arizona, Tucson, AZ, (2)University of Arizona, Mel & Enid Zuckerman College of Public Health, Tucson, AZ
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Sub-Saharan Africa has the world's lowest contraceptive prevalence rate. The aim of this study was to assess the impact of women's empowerment on use of modern contraceptive among women in sub-Saharan Africa.
Methods: Demography and Health Survey data from 27 sub-Saharan African countries collected from 2010 to 2014 were used for this analysis. Analytic sample was limited to 147,025 women who expressed desire to postpone pregnancy for two or more years and those who wanted no more children. Women's empowerment was measured by ability to: partake in healthcare decisions, make large household purchases, and make decision to visit relatives. Relationship between empowerment and contraception use was assessed using chi-square tests and multiple-logistic regression models. Analyses were conducted on SAS 9.4, and statistical significance was set at p<0.05.
Results: Prevalence of modern contraceptive use ranged from 9.6% in Benin to 62.5% in Zimbabwe. Indicators of women's empowerment were positively associated with higher odds of use of modern contraception. Women who were involved in their healthcare decision-making (aOR=1.22; 95% C.I.=1.17-1.27), in decisions to purchase large-household items (aOR=1.19; 1.15-1.24), and in decisions to visit relatives (aOR=1.17; 1.13-1.22) had higher odds of using modern contraception than women who were uninvolved in these key measures of empowerment.
Policy Implication: The findings underscore the need to consider the role of women's empowerment in efforts to promote use of modern contraceptives in sub-Saharan Africa. Consideration should be given to the role of men in increasing women's uptake of modern contraceptives in sub-Saharan Africa.
Biostatistics, economics Provision of health care to the public Public health or related research Social and behavioral sciences
Abstract
Use of dual HIV/syphilis rapid diagnostic tests to eliminate mother-to-child transmission of HIV and syphilis: Perspectives from women attending antenatal care in Malawi
Brandy Maddox, MPH1, Shaunta Wright, MPH1, Hazel Namadingo, BSc2, Virginia Bowen, PhD, MHS1, Geoffrey Chipungu, MBBS, DTM&H3 and Mary Kamb, MD, MPH1
(1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Malawi Epidemiology Intervention Research Unit, Lilongwe, Malawi, (3)Centers for Disease Control and Prevention Malawi, Lilongwe, Malawi
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
background: Globally, over 1.4 million pregnant women are infected with syphilis. Left untreated, maternal syphilis infections lead to severely adverse pregnancy outcomes. To prevent mother-to-child transmission of HIV and syphilis, Malawi National Guidelines specify universal, free-of-charge HIV and syphilis testing at the first antenatal visit. Given funding constraints, most women receive only HIV testing. Dual-platform rapid diagnostic tests (RDTs) integrating syphilis with more routine (and well-funded) HIV testing could increase antenatal testing for syphilis and improve infant health outcomes.
purpose: To identify potential barriers to national scale-up of a novel, dual HIV/syphilis RDT undergoing field evaluation, we conducted a formative assessment to understand pregnant women's antenatal experience, knowledge of HIV and syphilis, and willingness to pay for a dual RDT to alleviate funding constraints.
methods: We conducted four focus groups at two antenatal clinics (one participating field evaluation site and one non-evaluation site) that varied by level of specialty care. We translated discussions from Chichewa to English, and transcribed and coded discussions thematically using qualitative research software.
results: Twenty-nine women receiving antenatal care participated (mean age: 26.9). Most women (23) believed they were at risk for acquiring an STD, however, many were unaware that syphilis could cause poor pregnancy outcomes or that prenatal testing was recommended. Twenty-five women reported not receiving a syphilis test, while only one woman reported not receiving an HIV test. Participants expressed varying levels of concern about potential stock-outs of HIV and syphilis tests, some perceived syphilis as less harmful as it could be treated. The majority (27) believed having a syphilis or HIV test could likely improve infant health outcomes and most (23) would be willing to pay 1065 Kwacha ($1.45 USD, or 2 loaves of bread) for a dual RDT, because they want to know their health status.
conclusions: Maternal and child health programs considering scale-up of a dual HIV/syphilis RDT may need to address women's lack of understanding of the role of syphilis in pregnancy to ensure women obtain appropriate screening during antenatal care. Determining pregnant women's willingness to pay may offer an inexpensive option for low-resource settings considering implementation of dual RDTs.
Conduct evaluation related to programs, research, and other areas of practice Protection of the public in relation to communicable diseases including prevention or control Provision of health care to the public Public health or related research
Abstract
Amina's story: Improving maternal and child health outcomes throughout the continuum of care in northern Nigeria
Olugbenga Oguntunde, MD1, Irit Sinai2, Abdulaziz Mohammed3 and Ramatu Daroda3
(1)MNCH2 Program, Kano, Nigeria, (2)Palladium, Washington DC, DC, (3)DFID/MNCH2 PROGRAMME,, KANO, Nigeria
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background
Despite 20 years of maternal and child health (MCH) programming in northern Nigeria, the region's health indicators remain among the poorest in the world. TFR in 2013 was 6.7, and less than 3% of married women of reproductive health were using contraception. The Maternal, Newborn, and Child Health Programme (MNCH2), a DFID-funded 5-year project in six northern Nigeria states improves MCH through integrated MCH supply-side interventions and health-system strengthening, as well as programs to increase demand for and utilization of services. Project activities follow the reproductive life-span of Amina, a young married woman typical of many in northern Nigeria, seeing to all her health needs from pre-pregnancy, through pregnancy, postpartum, newborn and child health services. The project operates in targeted health facilities throughout supported states. Supply-side programming is supplemented by robust demand-side interventions.
Methods
The program improves the capacity of supported facilities to collect and report accurate and complete routine service statistics through the national District Health Information System (DHIS2), to provide quality data that were abstracted and analysed to review progress toward achieving project targets and assess preliminary outcome of this integrated approach to programming. We explore five outcome measures: (1) new family planning users, (2) women who had at least four antenatal care visits in their last pregnancy, (3) deliveries assisted by skilled birth attendants, (4) women who received postnatal care within 24 hours of delivery, and (5) one-year olds who were fully immunized. Analysis will follow quarterly trends for 2014, 2015 and the first half of 2016, comparing supported to other facilities.
Results
We compare state-level number of births attended by a skilled attendant in 2014 and 2015 as an illustrative example. In five states figures increased (range 3.4% in Jigawa to more than 80% in Kano). In Zamfara the figure reduced slightly. The observed increases may not be exclusively attributable to programming. Other contributing factors will be explored.
Conclusions
MNCH2's approach to integrating the full range of services with demand-side programming, to accommodate women like Amina throughout the continuum of care, appears to positively influence health outcomes of women and children in northern Nigeria.
Administer health education strategies, interventions and programs Other professions or practice related to public health Program planning Provision of health care to the public
Abstract
Adolescent Girls Initiative – Kenya: Applying Findings from a Process Evaluation to Improve Quality of Interventions for Very Young Adolescent Girls in Kenya
Karen Austrian, PhD and Eunice Muthengi, PhD, MPH
Population Council, Nairobi, Kenya
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Very young adolescent girls residing in marginalized areas in Kenya are at risk of experiencing negative health outcomes in the near future such as early sexual initiation, unintended pregnancy, early marriage, sexual and gender-based violence and school dropout. Therefore, it is critical to intervene before the myriad of challenges girls face result in outcomes that are irreversible or are costly to compensate for or reverse. Furthermore, in order to achieve well-being for girls in early and late adolescence, no single-sector intervention – whether it be health, prevention of violence, livelihoods, or education – will be adequate.
The Adolescent Girls Initiative–Kenya (AGI-K), a four-year longitudinal, randomized trial, will test combinations of interventions in four sectors in order to determine the most cost-effective approach to help girls make a healthy, safe and productive transition into adulthood. These interventions will be implemented in the Kibera slum of Nairobi, Kenya and rural villages in Wajir County, along the border of Somalia, and will comprise a combination of girl-level, household-level, and community-level interventions.
This presentation will describe lessons learned from a process evaluation conducted eight months into the two-year program implementation period to both improve the quality of interventions, as well as explore themes of self-esteem and experience of violence that emerged from the baseline data. Qualitative data was collected from girls participating in the program (n=72), as well as parents and key stakeholders (n=24). Content analysis was conducted using ATLAS.ti. Key findings will be highlighted and implications for future programming will be discussed.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning