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Gregson S.,Biomedical Research and Training Institute | Gregson S.,Imperial College London | Nyamukapa C.,Biomedical Research and Training Institute | Nyamukapa C.,Imperial College London | And 6 more authors.
Sexually Transmitted Diseases | Year: 2011

Objective: To add to the evidence on the impact of national HIV prevention programs in reducing HIV risk in sub-Saharan African countries. Methods: Statistical analysis of prospective data on exposure to HIV prevention programs, relatives with AIDS and unemployment, and sexual behavior change and HIV incidence, in a population cohort of 4047 adults, collected over a period (1998-2003) when HIV prevalence and risk-behavior declined in eastern Zimbabwe. Results: Exposure to HIV prevention programs and relatives with AIDS-but not unemployment-increased from 1998 to 2003. Men and women exposed to media campaigns and HIV/AIDS meetings had greater knowledge and self-efficacy, attributes that were concomitantly protective against HIV infection. Women attending community HIV/AIDS meetings before recruitment were more likely than other women to adopt lower-risk behavior (96.4% vs. 90.8%; adjusted odds ratio, 3.09; 95% confidence interval [CI], 1.27-7.49) and had lower HIV incidence (0.9% vs. 1.8%; adjusted incidence rate ratio, 0.63; 95% CI, 0.32-1.24) during the intersurvey period. Prior exposure to relatives with AIDS was not associated with differences in behavior change. More newly unemployed men as compared with employed men adopted lower-risk behavior (84.2% vs. 76.0%; adjusted odds ratio, 2.13; 95% CI, 0.98-4.59). Conclusions: Community-based HIV/AIDS meetings reduced risk-behavior amongst women who attended them, contributing to HIV decline in eastern Zimbabwe. © 2011 American Sexually Transmitted Diseases Association All rights reserved. Source

Herrmann M.,United Nations Population Fund UNFPA
Reproductive Health Matters | Year: 2014

The greatest challenge today is to meet the needs of current and future generations, of a large and growing world population, without imposing catastrophic pressures on the natural environment. Meeting this challenge depends on decisive policy changes in three areas: more inclusive economic growth, greener economic growth, and population policies. This article focuses on efforts to address and harness demographic changes for sustainable development, which are largely outside the purview of the current debate. Efforts to this end must be based on the recognition that demographic changes are the cumulative result of individual choices and opportunities, and that demographic changes are best addressed through policies that enlarge these choices and opportunities, with a focus on ensuring unrestricted and universal access to sexual and reproductive health information and services, empowering women to fully participate in social, economic and political life, and investing in the education of the younger generation beyond the primary level. The article provides a strong argument for why the Programme of Action that was agreed at the International Conference on Population and Development (ICPD) 20 years ago continues to hold important implications and lessons for the formulation of the post-2015 development agenda, which is expected to supersede the Millennium Development Goals (MDGs). © 2014 Reproductive Health Matters. Source

Jabeen H.,United Nations Population Fund UNFPA
Open House International | Year: 2014

Dhaka is one of the most vulnerable cities facing exacerbated disaster risks from climate change impacts. While these risks have escalated rapid population growth has made Dhaka one of the fastest growing megacities in Asia with a very high housing demand. In the absence of significant interventions from the public sector, the private sector has become responsible for 70 per cent of the city's physical development. The political economy of development and limitations in institutional arrangements allow private sector investors an almost free hand, resulting in increased and transferred risks to the public sector and city dwellers in general. Any post-disaster reconstruction in future will be influenced by these existing dynamics. Future plans for post-disaster reconstruction of housing in Dhaka must address issues of growing demand, limitations of risk-free land for development, ownership of land and housing, and limitations of resources. Source

Tran N.T.,University of New South Wales | Portela A.,World Health Organization | De Bernis L.,United Nations Population Fund UNFPA | Beek K.,University of Technology, Sydney
PLoS ONE | Year: 2014

Background: Given country demands for support in the training of community health workers (CHWs) to accelerate progress towards reaching the Millennium Development Goals in sexual and reproductive health and maternal, newborn, child, and adolescent health (SR/MNCAH), the United Nations Health Agencies conducted a synthesis of existing training resource packages for CHWs in different components of SR/MNCAH to identify gaps and opportunities and inform efforts to harmonize approaches to developing the capacity of CHWs. Methods: A mapping of training resource packages for CHWs was undertaken with documents retrieved online and from key informants. Materials were classified by health themes and analysed using agreed parameters. Ways forward were informed by a subsequent expert consultation. Results: We identified 31 relevant packages. They covered different components of the SR/MNCAH continuum in varying breadth (integrated packages) and depth (focused packages), including family planning, antenatal and childbirth care (mainly postpartum haemorrhage), newborn care, and childhood care, and HIV. There is no or limited coverage of interventions related to safe abortion, adolescent health, and gender-based violence. There is no training package addressing the range of evidence-based interventions that can be delivered by CHWs as per World Health Organization guidance. Gaps include weakness in the assessment of competencies of trainees, in supportive supervision, and in impact assessment of packages. Many packages represent individual programme efforts rather than national programme materials, which could reflect weak integration into national health systems. Conclusions: There is a wealth of training packages on SR/MNCAH for CHWs which reflects interest in strengthening the capacity of CHWs. This offers an opportunity for governments and partners to mount a synergistic response to address the gaps and ensure an evidence-based comprehensive package of interventions to be delivered by CHWs. Packages with defined competencies and methods for assessing competencies and supervision are considered best practices but remain a gap. © 2014 Tran et al. Source

Keyes E.B.,Columbia University | Haile-Mariam A.,World Health Organization | Belayneh N.T.,Federal Ministry of Health | Gobezie W.A.,BETA Development Consulting | And 3 more authors.
International Journal of Gynecology and Obstetrics | Year: 2011

Objective: To describe the methods used to implement Ethiopia's 2008 emergency obstetric and newborn care services (EmONC) assessment; highlight how the collaborative process contributed to immediate integration of results into national and subnational planning; and explain how the experience informed the development of a set of tools providing best practices and guidelines for other countries conducting similar assessments. Methods: A team of maternal and newborn health experts from the Federal Ministry of Health (FMOH), the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), together with representatives from the Ethiopian Society of Obstetricians and Gynecologists, provided technical guidance for the 18-month process and facilitated demand for and use of the assessment results. Eighty-four trained data collectors administered 9 data collection modules in 806 public and private facilities. Field work and data were managed by a private firm who, together with the core team, implemented a multi-layered plan for data quality. Columbia University's Averting Maternal Death and Disability Program provided technical assistance. Results: Results were published in national and regional reports and in 1-page facility factsheets informing subnational planning activities. Assessment results-which have been published in journal articles-informed water infrastructure improvements, efforts to expand access to magnesium sulfate, and FMOH and UN planning documents. The assessment also established a permanent database for future monitoring of the health system, including geographic locations of surveyed facilities. Conclusion: Ethiopia's assessment was successful largely because of active local leadership, a collaborative process, ample financial and technical support, and rapid integration of results into health system planning. © 2011 Elsevier Ireland Ltd. Source

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