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Global Health: Science and Practice (GHSP), a no-fee, peer-reviewed, open-access journal, is targeted to global health professionals, particularly program implementers, to validate their experiences and program results by peer reviewers and to share them with the greater global health community.
December 2014 | Volume 2 | Issue 4
Read the December 2014 issue of GHSP to find answers to these questions and more. View a list of all articles by article type below, or read and download the entire current issue online.
Visit the GHSP website to read and comment on the articles, and subscribe to receive alerts when new articles and issues are published.
Caution on corticosteroids for preterm delivery: learning from missteps
An important new study in lower-level health facilities in low- and middle-income countries found an increased risk of neonatal deaths with corticosteroid use in pregnant women with imminent preterm birth, in contrast with the positive results previously found in high-income countries. The surprising finding demonstrates that context matters. The increase appears largely due to steroids administered in cases that were not actually preterm, probably due to inaccurate pregnancy dating and challenges with diagnostic capacity. Promoting public health often requires decisions based on less-than-perfect evidence, but we must be vigilant about gathering and assessing new evidence and ready-to-change strategies.
Stephen Hodgins
It’s not Ebola … it’s the systems
The 2014 Ebola outbreak in West Africa demonstrates key deficiencies in investment in health systems. Despite some modest investment in health systems, our field has instead largely chosen to pursue shorter-term, vertical efforts to more rapidly address key global health issues such as smallpox, polio, malaria, and HIV and AIDS. While those efforts have yielded substantial benefits, we have paid a price for the lack of investments in general systems strengthening. The Ebola deaths we have seen represent a small portion of deaths from many other causes resulting from weak systems. Major systems strengthening including crucial nonclinical elements will not happen overnight but should proceed in a prioritized, systematic way.
Victor K. Barbiero
Breaking new ground in family planning communication
The Urban Reproductive Health Initiative has shown impact on contraceptive use from its communication components even within a few years, as described in two GHSP articles. One specifically addressed “ideation” about family planning in detail and was able to show both changes in ideation due to program exposure and correlated changes in contraceptive use. The other used a sophisticated analytical technique that indicated the observed changes in contraceptive use resulted from exposure to the communication efforts—and not just because people more prone to adopt family planning were also more likely to recall exposure to the communication messages.
A better future for injectable contraception?
- Provision of injectables through drug shops appears practicable and can contribute a marked share of family planning services.
- A potential longer-acting injectable providing at least 6 months of protection appeals to programmatic professionals.
- Subcutaneous administration of Depo-Prevera® offers major injectable improvements over the current intramuscular approach.
- Ironically, while injectable use will inevitably grow, better choice and wider availability of other methods—especially of long-acting and permanent methods—will reduce injectables' overall share.
The future of routine immunization in the developing world: challenges and opportunities
Vaccine costs in the developing world have grown from < US$1/child in 2001 to about $21 for boys and $35 for girls in 2014 as more and costlier vaccines are being introduced into national immunization programs. To address these and other challenges, additional efforts are needed to strengthen eight critical components of routine immunization: (1) policy, standards, and guidelines; (2) governance, organization, and management; (3) human resources; (4) vaccine, cold chain, and logistics management; (5) service delivery; (6) communication and community partnerships; (7) data generation and use; and (8) sustainable financing.
Angela K Shen, Rebecca Fields, Mike McQuestion
Strategies to reduce risks in ARV supply chains in the developing world
Key strategies of the main antiretroviral (ARV) procurement program for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to reduce supply chain risks include (1) employing pooled procurement to reduce procurement and shipping costs and to accommodate changing country needs by making stock adjustments at the regional level and (2) establishing regional distribution centers to facilitate faster turnaround of orders within defined catchment areas.
Chris Larson, Robert Burn, Anja Minnick-Sakal, Meaghan O’Keefe Douglas, Joel Kuritsky
A stewardship approach to shaping the future of public health supply chain systems
Guiding Principles: (1) Governments should see themselves as stewards of supply chains, providing vision, guidance, and oversight— not necessarily as operators of supply chains. (2) Governments should not be afraid to leverage the multiple supply chain actors and diverse options available; these can be woven into a coherent, integrated system, providing flexibility and reducing risk. (3) Governments will need new skills in leadership, regulation, market research, contract design, oversight of outsourced providers, financial analysis, and alliance-building.
Alan Bornbusch, Todd Dickens, Carolyn Hart, Chris Wright
Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation
Demand generation activities that were significantly associated with increased use of modern contraception in India (Uttar Pradesh), Kenya, Nigeria, and Senegal included (1) community outreach activities, such as home visits and group discussions about family planning; (2) local radio programs; and (3) branded slogans and print materials circulated widely across the city. Television programming was also significant in India and Nigeria. Exposure to more activities may increase women’s likelihood of using contraception.
Ilene S Speizer, Meghan Corroon, Lisa Calhoun, Peter Lance, Livia Montana, Priya Nanda, David Guilkey
Using behavior change communication to lead a comprehensive family planning program: the Nigerian Urban Reproductive Health Initiative
Greater exposure to a comprehensive family planning program in urban Nigeria that emphasized demand generation and communication theory was associated with improved ideation among women (their beliefs, ideas, and feelings about family planning), and more positive ideation was associated with greater contraceptive use, especially among the poor. Improving providers’ knowledge, attitudes, and skills was also key. By the end of the observation period, outreach through mobile service delivery contributed nearly one-half of the project clinics’ family planning services.
Susan Krenn, Lisa Cobb, Stella Babalola, Mojisola Odeku, Bola Kusemiju
Strengthening government management capacity to scale up HIV prevention programs through the use of technical support units: lessons from Karnataka state, India
A Technical Support Unit of managerial and technical experts, embedded in but distinct from the government, provided support in five key areas: strategic planning; monitoring and evaluation; supportive supervision; training; and information, education, and communication. This model likely contributed to effective and rapid scale up of Karnataka state’s HIV prevention program. A clear mandate, close collaboration, and well-defined roles were keys to success.
Sema K Sgaier, John Anthony, Parinita Bhattacharjee, James Baer, Vidyacharan Malve, Aparajita Bhalla, Vijaykumar S Hugar
Policy and programmatic considerations for introducing a longer-acting injectable contraceptive: perspectives of stakeholders from Kenya and Rwanda
Unique attributes of a longer-acting injectable would likely appeal to both existing injectable users and new clients, both for spacing and for limiting births, and allow health systems to operate more efficiently. Considerations for enhancing successful introduction of this potential new method include keeping the cost low, expanding access through community-based distribution, and training providers to improve practices about injectables in general.
Kevin McKenna, Jennet Arcara, Kate H Rademacher, Caroline Mackenzie, Fidele Ngabo, Emmanuel Munyambanza, Jennifer Wesson, Elizabeth E Tolley
Getting closer to people: family planning provision by drug shops in Uganda
Private drug shops can effectively provide contraceptive methods, especially injectables, complementing government services. Most drug-shop clients in four peri-urban areas of Uganda were continuing users of Depo-Prevera®, had switched from other providers, mainly government clinics, because the drug shops had fewer stock-outs, were more convenient (closer location, shorter waiting time, more flexible hours), and were satisfied with the quality of services. The drug shops provided a substantial part of the total market share for family planning services in their areas.
Angela Akol, Dawn Chin-Quee, Patricia Wamala-Mucheri, Jane Harriet Namwebya, Sarah Jilani Mercer, John Stanback
Maternal mental health in Amhara region, Ethiopia: a cross-sectional survey
Poor mental health, including suicidal thoughts, affects a substantial proportion of surveyed women who are up to 2 years postpartum in the Amhara region of Ethiopia. Opportunities for integrating basic psychosocial mental health services into maternal and child health services should be explored.
Joy Noel Baumgartner, Angela Parcesepe, Yared Getachew Mekuria, Dereje Birhanu Abitew, Wondimu Gebeyehu, Francis Okello, Dominick Shattuck
Courage is not the absence of fear: responding to the Ebola outbreak in Liberia
Linda Meta Mobula
GHSP is supported by the U.S. Agency for International Development and published by the Knowledge for Health project at the Johns Hopkins Center for Communication Programs.
Learn more about GHSP on its website: www.ghspjournal.org.
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