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
Modeling Outputs Can Be Valuable When Uncertainty Is Appropriately Acknowledged, but Misleading When Not
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.
Extended Effectiveness of the Etonogestrel-Releasing Contraceptive Implant and the 20 μg Levonorgestrel-Releasing Intrauterine System for 2 Years Beyond U.S. Food and Drug Administration Product Labeling
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).
From Research to Policy: The WHO Experience With Developing Guidelines on the Potential Risk of HIV Acquisition and Progestogen-Only Contraception Use
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.
Interventions for Preventing Unintended, Rapid Repeat Pregnancy Among Adolescents: A Review of the Evidence and Lessons From High-Quality Evaluations
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.
Maternal and Neonatal Directed Assessment of Technologies (MANDATE): Methods and Assumptions for a Predictive Model for Maternal, Fetal, and Neonatal Mortality Interventions
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.
Re-Evaluating the Possible Increased Risk of HIV Acquisition With Progestin-Only Injectables Versus Maternal Mortality and Life Expectancy in Africa: A Decision Analysis
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.
Improving Contraceptive Access, Use, and Method Mix by Task Sharing Implanon Insertion to Frontline Health Workers: The Experience of the Integrated Family Health Program in Ethiopia
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.
Equal Opportunity, Equal Work: Increasing Women's Participation in the U.S. President's Malaria Initiative Africa Indoor Residual Spraying Project
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 2002 to 2012 Fertility Stall and Parallel USAID Investments in Family Planning: Lessons From an Assessment to Guide Future Programming
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.
Food Security and Nutrition Outcomes of Farmer Field Schools in Eastern Democratic Republic of the Congo
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.
What Factors Contribute to Postabortion Contraceptive Uptake By Young Women? A Program Evaluation in 10 Countries in Asia and sub-Saharan Africa
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.
Harmonizing Methods for Estimating the Impact of Contraceptive Use on Unintended Pregnancy, Abortion, and Maternal Health
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.
An NGO-Implemented Community–Clinic Health Worker Approach to Providing Long-Term Care for Hypertension in a Remote Region of Southern India
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.
More Than Bar Codes: Integrating Global Standards-Based Bar Code Technology Into National Health Information Systems in Ethiopia and Pakistan to Increase End-to-End Supply Chain Visibility
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.
High Background Congenital Microcephaly in Rural Guatemala: Implications for Neonatal Congenital Zika Virus Infection Screening
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.
Authors' Response to Editorial: Maternal Death Surveillance and Response: A Tall Order for Effectiveness in Resource-Poor Settings