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Polis C.B.,United States Agency for International Development USAID | Phillips S.J.,World Health Organization | Curtis K.M.,Centers for Disease Control and Prevention | Westreich D.J.,University of North Carolina at Chapel Hill | And 4 more authors.
Contraception | Year: 2014

Whether use of various types of hormonal contraception (HC) affect risk of HIV acquisition is a critical question for women's health. For this systematic review, we identified 22 studies published by January 15, 2014 which met inclusion criteria; we classified thirteen studies as having severe methodological limitations, and nine studies as "informative but with important limitations". Overall, data do not support an association between use of oral contraceptives and increased risk of HIV acquisition. Uncertainty persists regarding whether an association exists between depot- medroxyprogesterone acetate (DMPA) use and risk of HIV acquisition. Most studies suggested no significantly increased HIV risk with norethisterone enanthate (NET-EN) use, but when assessed in the same study, point estimates for NET-EN tended to be larger than for DMPA, though 95% confidence intervals overlapped substantially. No data have suggested significantly increased risk of HIV acquisition with use of implants, though data were limited. No data are available on the relationship between use of contraceptive patches, rings, or hormonal intrauterine devices and risk of HIV acquisition. Women choosing progestin-only injectable contraceptives such as DMPA or NET-EN should be informed of the current uncertainty regarding whether use of these methods increases risk of HIV acquisition, and like all women at risk of HIV, should be empowered to access and use condoms and other HIV preventative measures. Programs, practitioners, and women urgently need guidance on how to maximize health with respect to avoiding both unintended pregnancy and HIV given inconclusive or limited data for certain HC methods. © 2014 Elsevier Inc. All rights reserved.


Martorell R.,Emory University | Ascencio M.,Direccion de Desarrollo Cientifico y Tecnologico en Salud | Tacsan L.,Direccion de Desarrollo Cientifico y Tecnologico en Salud | Alfaro T.,Instituto Costarricense Of Investigacion Y Ensenanza En Nutricion Y Salud Inciensa | And 4 more authors.
American Journal of Clinical Nutrition | Year: 2015

Background: Food fortification is one approach for addressing anemia, but information on program effectiveness is limited. Objective: We evaluated the impact of Costa Rica's fortification program on anemia in women aged 15-45 y and children aged 1-7 y. Design: Reduced iron, an ineffective fortificant, was replaced by ferrous fumarate in wheat flour in 2002, and ferrous bisglycinate was added to maize flour in 1999 and to liquid and powdered milk in 2001. We used a one-group pretest-posttest design and national survey data from 1996 (baseline; 910 women, 965 children) and 2008-2009 (endline; 863 women, 403 children) to assess changes in iron deficiency (children only) and anemia. Data were also available for sentinel sites (1 urban, 1 rural) for 1999-2000 (405 women, 404 children) and 2008-2009 (474 women, 195 children), including 24-h recall data in children. Monitoring of fortification levels was routine. Results: Foods were fortified as mandated. Fortification provided about one-half the estimated average requirement for iron in children, mostly and equally through wheat flour and milk. Anemia was reduced in children and women in national and sentinel site comparisons. At the national level, anemia declined in children from 19.3% (95% CI: 16.8%, 21.8%) to 4.0% (95% CI: 2.1%, 5.9%) and in women from 18.4% (95% CI: 15.8%, 20.9%) to 10.2% (95% CI: 8.2%, 12.2%). In children, iron deficiency declined from 26.9% (95% CI: 21.1%, 32.7%) to 6.8% (95% CI: 4.2%, 9.3%), and iron deficiency anemia, which was 6.2% (95% CI: 3.0%, 9.3%) at baseline, could no longer be detected at the endline. Conclusions: A plausible impact pathway suggests that fortification improved iron status and reduced anemia. Although unlikely in the Costa Rican context, other explanations cannot be excluded in a pre/post comparison. © 2015 American Society for Nutrition


Haddad L.B.,Emory University | Polis C.B.,United States Agency for International Development USAID | Sheth A.N.,Emory University | Brown J.,Texas Tech University | And 4 more authors.
Current HIV/AIDS Reports | Year: 2014

Effective family planning with modern contraception is an important intervention to prevent unintended pregnancies which also provides personal, familial, and societal benefits. Contraception is also the most cost-effective strategy to reduce the burden of mother-to-child HIV transmission for women living with HIV who wish to prevent pregnancy. There are concerns, however, that certain contraceptive methods, in particular the injectable contraceptive depot medroxyprogesterone acetate (DMPA), may increase a woman’s risk of acquiring HIV or transmitting it to uninfected males. These concerns, if confirmed, could potentially have large public health implications. This paper briefly reviews the literature on use of contraception among women living with HIV or at high risk of HIV infection. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommendations place no restrictions on the use of hormonal contraceptive methods by women with or at high risk of HIV infection, although a clarification recommends that, given uncertainty in the current literature, women at high risk of HIV who choose progestogen-only injectable contraceptives should be informed that it may or may not increase their risk of HIV acquisition and should also be informed about and have access to HIV preventive measures, including male or female condoms. © 2014, Springer Science+Business Media New York.


Mah T.L.,United States Agency for International Development USAID
Sexually Transmitted Diseases | Year: 2010

Concurrent sexual partnerships are an important behavioral driver of HIV epidemics. This analysis examines the prevalence and correlates of concurrency among young adults in the Cape Metropolitan Area, South Africa. 13% reported concurrency during their last sexual partnership with variability by sex and race. Concurrency was associated wiht race, knowledge of a partner's infidelity, and other risky sexual behaviors. © Copyright 2010 American Sexually Transmitted Diseases Association.


Ebot J.O.,United States Agency for International Development USAID
Journal of Health, Population and Nutrition | Year: 2015

Background: Although immunizations are efficient and cost effective methods of reducing child mortality, worldwide, approximately 2 million children die yearly of vaccine-preventable diseases. Researchers and health organizations have detailed information on the positive relationship between women's autonomy and children's health outcomes in developing countries. Methods: This study investigates the links between women's household autonomy and children's immunization status using data from a nationally representative sample of children aged 12-30 months (N = 2941) from the 2011 Ethiopia Demographic and Health Survey. Results: The results showed that women's socioeconomic status and household autonomy were significantly associated with children's immunization status. Conclusion: Overall, the implications of this study align with those of the Millennium Development Goal #3: improvements in women's household autonomy are linked to more positive child health outcomes. © 2015 Ebot.


Lawlor K.,University of North Carolina at Chapel Hill | Madeira E.M.,The Nature Conservancy | Blockhus J.,The Nature Conservancy | Ganz D.J.,United States Agency for International Development USAID
Forests | Year: 2013

The advent of initiatives to reduce emissions from deforestation and degradation and enhance forest carbon stocks (REDD+) in developing countries has raised much concern regarding impacts on local communities. To inform this debate, we analyze the initial outcomes of those REDD+ projects that systematically report on their socio-economic dimensions. To categorize and compare projects, we develop a participation and benefits framework that considers REDD+'s effects on local populations' opportunities (jobs, income), security (of tenure and ecosystem services), and empowerment (participation in land use and development decisions). We find material benefits, in terms of jobs and income, to be, thus far, modest. On the other hand, we find that many projects are helping populations gain tenure rights. A majority of projects are obtaining local populations' free, prior, and informed consent (FPIC). However, for those projects interacting with multiple populations, extent of participation and effects on forest access are often uneven. Our participation and benefits framework can be a useful tool for identifying the multi-faceted socio-economic impacts of REDD+, which are realized under different timescales. The framework and initial trends reported here can be used to build hypotheses for future REDD+ impact evaluations and contribute to evolving theories of incentive-based environmental policy. © 2013 by the authors.


Boateng D.,Kwame Nkrumah University Of Science And Technology | Kwapong G.D.,United States Agency for International Development USAID | Agyei-Baffour P.,Kwame Nkrumah University Of Science And Technology
BMC Women's Health | Year: 2013

Background: Mother-to-Child Transmission (MTCT) has been identified as the greatest means of HIV infection among children. Adherence to antiretroviral drugs is necessary to prevent drug resistance and MTCT of HIV among HIV positive women. However, there is a gap in clients' knowledge, attitudes and perceptions of antiretroviral therapy (ART) and Prevention of Mother-To-Child Transmission (PMTCT) which influence their decision to adhere to ART.Methods: The study was a descriptive cross-sectional employing both qualitative and quantitative methods. The study involved 229 HIV positive women in reproductive age (18 - 49 years) and had been on ART for at least six months. Fourteen health workers were also included in the qualitative study. Respondents were selected from three ART centers in the Kumasi Metropolis through systematic random sampling from August to November 2011. HIV positive women who had consistently missed two or more ART appointments within the previous two months were classified as defaulters. Data was analyzed with SPSS 19 and STATA 11. Logistic regression was run to assess the odds ratios at 95% confidence level.Results: The ART defaulter rate was 27% and clients had good knowledge about ART and PMTCT. More than 90% of the HIV positive women had inadequate knowledge about ART and PMTCT and these women were more likely to default ART (OR = 3.5; 95% CI = 1.89, 6.21). The educational background of HIV positive women did not have significant influence on their knowledge of ART and PMTCT.Conclusions: Mothers, knowledge and understanding of ART and PMTCT could influence their adherence to ART. Educational interventions which target the understanding of both the literate and illiterate women in society are necessary to develop positive behaviors and enhance adherence to ART. © 2013 Boateng et al.; licensee BioMed Central Ltd.


Andoseh S.,United States Agency for International Development USAID | Bahn R.,1500 Pennsylvania Ave. | Gu J.,Pacific Biosciences
Food Policy | Year: 2014

The United States Agency for International Development (USAID), like many other development agencies and donors, increasingly emphasizes evidence-based programming. This requires assessments of project performance at all stages of implementation, comprising ex-ante impact assessment, monitoring and evaluation, and ex-post attribution of outcomes. Ex-ante impact assessment, in particular, involves performing Cost-Benefit Analysis (CBA) to determine the Expected Net Present Value (ENPV) of the project in question. Unfortunately, the traditional ENPV approach has proven inadequate for dealing with uncertainty in the timing of investments and flexibility in future decision making. This is especially relevant for Research and Development (R&D) projects which require several stages of product development and multiple rounds of testing prior to releasing final products. As a consequence, the real-options approach to CBA has increasingly been used to evaluate private sector R&D projects. This paper advocates for the adoption of the real options approach in the evaluation of public investments in agricultural research, and illustrates its practical utility with an assessment conducted by USAID to determine the economic viability of a proposed project to develop improved varieties of critical food security crops in Uganda. © 2013 .


Singh K.,University of North Carolina at Chapel Hill | Moran A.,United States Agency for International Development USAID | Story W.,University of North Carolina at Chapel Hill | Bailey P.,FHI 360 | Chavane L.,Health Integrated
International Journal of Gynecology and Obstetrics | Year: 2014

Objective To review national data on HIV and malaria as causes of maternal death and to determine the importance of looking at maternal mortality at a subnational level in Mozambique. Methods Three national data surveys were used to document HIV and malaria as causes of maternal mortality and to assess HIV and malaria prevention services for pregnant women. Data were collected between 2007 and 2011, and included population-level verbal autopsy data and household survey data. Results Verbal autopsy data indicated that 18.2% of maternal deaths were due to HIV and 23.1% were due to malaria. Only 19.6% of recently pregnant women received at least two doses of sulfadoxine-pyrimethamine for intermittent preventive treatment, and only 42.3% of pregnant women were sleeping under an insecticide-treated net. Only 37.5% of recently pregnant women had been counseled, tested, and received an HIV test result. Coverage of prevention services varied substantially by province. Conclusion Triangulation of information on cause of death and coverage of interventions can enable appropriate targeting of maternal health interventions. Such information could also help countries in Sub-Saharan Africa to recognize and take action against malaria and HIV in an effort to decrease maternal mortality. © 2014 International Federation of Gynecology and Obstetrics.


Singh K.,University of North Carolina at Chapel Hill | Story W.T.,University of North Carolina at Chapel Hill | Moran A.C.,United States Agency for International Development USAID
Maternal and Child Health Journal | Year: 2016

Objective: We assess how countries in regions of the world where maternal mortality is highest—South Asia and Sub-Saharan Africa—are performing with regards to providing women with vital elements of the continuum of care. Methods: Using recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care—at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant and postnatal checks for the mother within the first 24 h since birth. Family planning counseling within a year of birth was also included in the descriptive analyses. Results: Results indicated that a major drop-out (>50 %) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (<5 %) who do not receive any antenatal care go on to have a skilled delivery or receive postnatal care. Women who receive some or all the elements of the continuum of care have greater autonomy and are richer and more educated than women who receive none of the elements. Conclusion: Understanding where drop-out occurs and who drops out can enable countries to better target interventions. Four or more ANC visits plays a pivotal role within the continuum of care and warrants more programmatic attention. Strategies to ensure that vital services are available to all women are essential in efforts to improve maternal health. © 2015, Springer Science+Business Media New York.

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