December 2017 | Volume 5 | Number 4
- What should policy makers understand about the limits of modeling approaches that project the impact of health interventions?
- Should the duration of effectiveness of Implanon and Mirena be extended?
- Which interventions are effective for preventing unintended, rapid repeat pregnancies among adolescents?
- How did the PMI Africa Indoor Residual Spraying Project increase the number of women in supervisory roles?
- Can community health workers provide long-term care for patients with hypertension?
- Do farmer field schools that focus on improving farmers’ agricultural practices also have impact on child nutritional status?
Read the December issue of GHSP to find answers to these questions and more. View a list of all articles by article type below or online.
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TABLE OF CONTENTS
EDITORIALS
While modeling approaches seek to draw on the best available evidence to project health impact of improved coverage of specific interventions, uncertainty around the outputs often remains. When the modeling estimates are used for advocacy, these uncertainties should be communicated to policy makers clearly and openly to ensure they understand the model's limits and to maintain their confidence in the process.
COMMENTARIES
Recently published evidence from 2 large studies find that the duration of effectiveness of the etonorgestrel-releasing contraceptive implant to be at least 5 years (compared with the current 3-year label), and for the 20 μg levonorgestrel-releasing intrauterine system at least 7 years (compared with the current 5-year label).
To develop guidance for women at high risk of HIV, WHO carefully considered the risks of maternal morbidity and mortality from unintended pregnancy against possible increased risk of HIV acquisition with injectable use. Among the many challenges: (1) balancing timeliness of changing the guidance against the potential impact of it; (2) engaging a range of stakeholders; (3) translating complex research and policy messages to clients; (4) needing additional research; and (5) monitoring and evaluating successes and challenges with implementing new guidelines.
REVIEWS
Evidence shows that effective prevention of rapid repeat pregnancy among adolescents links adolescent-friendly clinical contraceptive services with non-clinical interventions that contribute to positive youth development.
ORIGINAL ARTICLES
MANDATE is a mathematical model designed to estimate the relative impact of different interventions on maternal, fetal, and neonatal lives saved in sub-Saharan Africa and India. A key advantage is that it allows users to explore the contribution of preventive interventions, diagnostics, treatments, and transfers to higher levels of care to mortality reductions, and at different levels of penetration, utilization, and efficacy.
Our model suggests that removing progestin-only injectables in Africa would have a net negative effect on maternal health, life expectancy, and mortality under a variety of scenarios.
Between 2009 and 2015, 1.2 million women received Implanon implants from trained Health Extension Workers. Of the approximately 7,000 implant service visits made during the first 6 months, 25% were among women who had never used contraception before.
Promotion of gender policies led to increased hiring of women in supervisory roles in a large indoor residual spraying (IRS) program with no meaningful differences in IRS output between men and women spray operators.
Jordan's limited method mix, which has shifted toward less effective methods such as withdrawal and condoms, is a likely contributor to the plateau, coupled with social and cultural norms that discourage contraceptive use, such as preference for large family size and pressure to have a child immediately after marriage. Greater investment in social and behavior change and advocacy for stronger programming efforts are warranted.
A farmer field school program in food-insecure areas had positive impacts on household food security but not child nutritional status. Similar agricultural interventions may benefit food security, but the more difficult-to achieve improvements in child nutrition status may require more focused and integrated programming approaches.
Across the 10 countries, 77% of 921,918 women left with a contraceptive method after receiving abortion care. While contraceptive uptake was high among all age groups, adolescents ages 15–19 were less likely to choose a method than women 25 years or older.
METHODOLOGIES
Five models estimate the impact of family planning on health outcomes, but the estimates previously have diverged because the models used different assumptions, inputs, and algorithms. After a collective harmonization process, the models now produce more similar estimates although they retain some minimal differences. These models assist in planning, resource allocation, and evaluation.
Paid CHWs screened for hypertension in the community, referred cases to the clinic for diagnosis and initial treatment by a physician, and then monitored patients who had well-controlled blood pressure including dispensing maintenance medications prescribed by the physician. Blood pressure control was successful in the majority of such patients.
Bar codes can help track and trace health products in the supply chain. But to do so efficiently, they should be based on global standards rather than a proprietary system, and the captured data should be integrated into national health information systems to achieve end-to-end data visibility.
STUDENT ARTICLES — DOCTORAL
A variety of microcephaly case definitions detect high background prevalence in rural Guatemala, which complicates congenital Zika screening efforts. In addition, gestational age is needed for most screening tools but is usually unknown in low-resource settings. Fenton growth curves, originally designed for use in preterm infants, offer a standardized approach to adjust for unknown gestational age and may improve screening efforts.
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