ICRH Belgium Newsletter
15th of March, 2012
PROJECTS
MOMI STARTS TO RUN... its second project year
Researchers from the eight MOMI partners joined in Ouagadougou last February to discuss the progress made in the MOMI project during the first year and to pave the ways for smooth implementation of the work packages during the second project year.
After the opening ceremony with main stakeholders from the Ministry of Research and Innovation, the Ministry of Health, international development agencies and staff from the organising partner IRSS, the MOMI team conversed during three days about each of the ten work packages which form the five-year research project.
The core research work packages which are currently being conducted are the critical review of maternal; newborn and child health (MNCH) policies in the four study countries (work package 2, led by UCL) and the detailed situation analysis of MNCH services and care at the four study sites (work package 3, led by FMUP). This implies that the local teams are at present collecting and analysing data that will inform the MOMI project about the current MNCH policies and services and that will feed into the future work packages which will determine, implement and evaluate an optimum package of postpartum interventions in the four study sites. Despite some delays in certain project activities at the start of the project, the project progresses well and the deadlines for the first year deliverables and milestones have been met. The meeting ended in a positive spirit and encouraged all team members to continue working towards a tangible project outcome with a significant effect in the postpartum health care for mothers and their newborns in Africa.
After the three days' meeting, a one-day field trip was organised by IRSS to Kaya district, the MOMI study site in Burkina Faso. Meetings were programmed with the chief medical officer from Kaya district, IRSS staff involved in the surveillance KADESS, the medical doctor and nurses at an urban Centre de Santé et de Promotion Sociale and the gynaecologist at the Centre Hôpitalier Régional in Kaya. The field trip certainly contributed to a better understanding of the work of IRSS and KADESS, and of the specificities of the study site that is selected for the MOMI interventions in Burkina Faso.
The 'Missed Opportunities in Maternal and Infant Health' (MOMI) project focuses on postpartum health care delivery for mothers and newborns in four sub-Saharan countries (Burkina Faso, Kenya, Malawi and Mozambique) throughout the first year after childbirth. The MOMI project is implemented by a consortium of eight research institutions: the International Centre for Reproductive Health (ICRH) of Ghent University in Belgium is the overall research coordinator and the other consortium partners are: the Institut de Recherche en Sciences de la Santé (IRSS) in Burkina Faso, the International Centre for Reproductive Health (ICRHK) in Kenya, the Parent and Child Initiative of the Kamuzu Central Hospital and Ministry of Health (PACHI) in Malawi, the International Centre for Reproductive Health (ICRHM) in Mozambique, the Eduardo Mondlane University (UEM) in Mozambique, the Medical Faculty of the University of Porto (FMUP) in Portugal and the University College of London (UCL) in the United Kingdom.
More information: Els.duysburgh@ugent.be and birgit.kerstens@ugent.be
From left to right: Danielle Belemsaga (IRSS), Sue Mann (UCL), Sofia Lopes (FMUP), Nafissa Osman (UEM), Bejoy Nambiar (UCL), Gibson Masache (PACHI), Wendyam Charles Kabore (IRSS), Seni Kouanda (IRSS), Irene Jao (ICRHK), Beatrice Crahay (ICRHM), Severiano Foia (UEM), Kishor Mandaliya (ICRHK), Els Duysburgh (ICRH), Tim Colbourn (UCL), Christine Katingima (ICRHK), Henrique Barros (FMUP), Birgit Kerstens (ICRH).
LuMiMA: sensitization on Millennium Development Goals 4 and 5
ICRH obtained funding from the Federal Public Service Foreign Affairs, Foreign Trade and Development Cooperation to elaborate the short term project, called LuMIA, on Millennium development Goals 4 and 5 (child health and maternal health)
On May 10th 2012 ICRH will organize the unique event ‘LuMiMA’. This event includes an information market and quiz on the topic of child and maternal health. The market and quiz aim at informing -principally students and personal of Ghent University Association – about the complexity of factors that determine child and maternal health. Various speakers and organizations working in the field will be present during the information market to bring their view on the topic. Related expositions and videos will be shown. In the evening, during the quiz, participants will challenge some eminent professors, among which Marleen Temmerman, to decide who knows most about the different causes and consequences related to child and maternal health and mortality. The team that gets to the finals, wins a trip to Kenya to visit ICRH projects related to child and maternal health. If you would like to read more details about the LuMiMa project, please keep an eye on the ICRH-website. More information will be published soon. Or you can also contact: JulieG.Deman@ugent.be or SaraA.demeyer@ugent.be
Mother, new-born and child services in Mozambique
UNICEF has awarded a two year grant to ICRH Mozambique for a project aimed at improving quality, access and utilization of mother, new-born and child services in Tete province.
Attainment of Millennium Development Goal 4 and 5 remain important priorities of the Mozambican government. To respond to the high maternal and infant mortality rates, ICRH-Mozambique started in January 2012 a two-year project in Tete Province. This province of 2.1 million inhabitants in the central region of Mozambique remains a deprived area despite strong economic development. While coverage of institutional births is approximately 55%, the caesarean section rate is very low at 1% and neonatal mortality is estimated at 40.9 per 1.000 live births. HIV prevalence in the age group 15-49 years is currently estimated at 7.0%.
To improve quality, access and utilization of mother, new-born and child services in Tete province, ICRH-M will support transfer of knowledge to health workers with particular focus to emergency obstetric and neonatal care and infant and child nutrition. ICRH-M will also collaborate with patient support groups linked to HIV prevention and treatment programmes to strengthen linkages with mother, new-born and child health services at community and health facility level. Operational research is planned in particular to identify barriers and to design solutions for quality institutional obstetric care. A longitudinal study to evaluate the impact and feasibility of implementation of the new PMTCT guidelines on the prevalence of paediatric HIV infection in HIV exposed infants in Tete Province is currently under development.
More information: Beatrice Crahay icrh.coord@tdm.co.mz
ICRH PEOPLE
Wim Delva
ICRH visting professor Wim Delva is to become Chief researcher / deputy director at the South African Centre for Epidemiological Modelling and Analysis (SACEMA) as of 1 June.
His appointment entails both research and capacity building activities. At the core of his research mandate are a number of mathematical modelling projects related to the impact of earlier initiation of HIV treatment on the prevention of new HIV infections and HIV-related deaths. He will also be involved in statistical and epidemiological analyses of the complex sexual behaviour of disadvantaged communities around Cape Town. A number of Master's and PhD students from both Belgium and South Africa are involved in these research projects under Wim's (co-)supervision.
More information: wim.delva@ugent.be
Julie Deman
On March 1, Julie joined ICRH to work at the LuMIA-project, an information and sensitization initiative about the infant mortality and maternal health. 
Prior to joining ICRH, Julie was working at JOETZ vzw as a Projectcoordinator Health Promotion & Youth Experience Travels. She obtained a master degree in Health Prevention & Promotion at Ghent University. After her studies she went for a half a year to India to collaborate in a project that is promoting rights of women and children, and as result she is still working as a secretary at Nanri vzw that supports projects in India & Nepal. After her stay in India, she started working at the Red Cross Refugee Centre in Antwerp as an assistant (responsible for the women activities & health prevention, including HIV-education) and for a short while at Studio Globo (global education for children). In 2010, Julie has been doing volunteer work at ICRH for the project ‘Vulnerable Migrants & Sexual Health’.
More information: julieg.deman@ugent.be
PUBLICATIONS
Unsafe sex among HIV-infected women
A cohort analysis examined changes in sexual behavior and determinants of unsafe sex among HIV-infected women in the 24 months after delivery in Burkina Faso and Kenya.
Women were followed during pregnancy and until 12-24 months after delivery. At each visit, structured questionnaires were administered about sexual activity and condom use, and risk-reduction counseling and condoms were provided. At study entry, a median 2 months after HIV testing, 411/770 (53.4%) of women reported partner disclosure, increasing to 284/392 (71.9%) at the final visit. Although most partners were supportive following disclosure, between 5%-10% of disclosed women experienced hostile or unsupportive partner responses during follow-up visits. At each visit, about a third of sexually-active women reported unsafe sex (unprotected sex with HIV-uninfected or unknown status partner). In multivariable logistic regression, unsafe sex was 1.70-fold more likely in Kenyan than Burkinabe women (95%CI?=?1.14-2.54), and in those with less advanced HIV disease or aged 16-24. Compared to women who disclosed their status to partners and others, unsafe sex was over 6-fold higher in non-disclosers (95%CI?=?3.31-12.11), the effect size reducing with increasing disclosure.
The authors conclude that HIV-infected women who recently delivered have a high potential for further HIV transmission, especially as HIV-discordance is common in Africa. Longitudinal care for women, including positive-prevention interventions, is needed within new services providing antiretroviral prophylaxis during breastfeeding - this repeated interface with services could focus on reducing unsafe sex. Much remains unknown about how to facilitate beneficial disclosure.
The cohort analysis was nested within a prevention of mother-to-child transmission trial in Burkina Faso (n?=?339) and Kenya (n?=?432).
Changes in sexual behaviour among HIV-infected women in West and East Africa in the first 24 months after delivery. Irungu E, Chersich MF, Sanon C, Chege R, Gaillard P, Temmerman M, Read JS, Luchters S; for the Kesho Bora Study Group. AIDS. 2012 Feb 15. [Epub ahead of print]
HIV knowledge and prevention behaviors of male sex workers
Evaluation of the impact of a peer-driven intervention on male sex workers who sell sex to men in Mobasa, Kenya.
Targeting most at-risk populations is an essential component of HIV prevention strategies. Peer education programmes have been found to increase HIV knowledge, condom use and safer sex behaviors among female sex workers in Africa and men who have sex with men elsewhere. Using time-venue sampling, a baseline survey of 425 male sex workers was conducted in late 2006, after which, 40 peer educators were trained in HIV prevention, basic counseling skills and distribution of condoms and lubricants. A follow-up time-venue survey of 442 male sex workers was conducted in early 2008, and pre- and post-intervention changes were examined. The impact of peer educator exposure on HIV knowledge and condom use was analyzed. Positive changes in HIV prevention behaviors were observed, including increases in consistent use of condoms with both male clients (35.9%-50.2%, p<0.001) and non-paying male partners (27.4%-39.5%, p=0.008). Exposure to peer educators and ever having been counseled or tested for HIV were associated with consistent condom use in multivariate analysis. Peer educator contact was also associated with improved HIV knowledge and use of water-based lubricants. The authors conclude that peer outreach programming reached highly stigmatized male sex workers in Mombasa, resulting in significant, but limited, improvements in HIV knowledge and prevention behaviors. Improved peer coverage and additional prevention initiatives are needed to sufficiently mitigate HIV transmission.
The impact of peer outreach on HIV knowledge and prevention behaviours of male sex workers in Mombasa, Kenya. Geibel S, King'ola N, Temmerman M, Luchters S. Sex Transm Infect. 2012 Feb 13. [Epub ahead of print]
‘Human Papillomavirus and related diseases – from bench to bedside’
The ICRH cervical cancer research team has edited two books providing the latest information on a wide range of topics related to HPV and cervical cancer.
Cervical cancer remains a highly prevalent cancer among women worldwide, with the highest burden of disease in developing countries. Unfortunately, cervical cancer affects women at a very young age. In essence, cervical cancer is a preventable disease, and the introduction of different prevention techniques and vaccination has proven to be highly effective. Regrettably, the global burden of disease is still very high and important efforts need to be made to fight cervical cancer.
Cervical cancer research demands a multidisciplinary approach, and needs to bring efforts by different specialists together. Therefore, these books are meant to reach a broad audience, including fundamental scientists “from bench” and clinicians “to bedside”.
The publications can be downloaded at:
Clinical Aspects: http://www.intechopen.com/books/show/title/human-papillomavirus-and-related-diseases-from-bench-to-bedside-a-clinical-perspective
Research Aspects: http://www.intechopen.com/books/show/title/human-papillomavirus-and-related-diseases-from-bench-to-bedside-research-aspects
More information: Davy Vanden Broeck: Davy.vandenbroeck@ugent.be
SRHR of adolescents in Colombia
A paper on dignity and the right of internally displaced adolescents in Colombia to sexual and reproductive health.
In Colombia, national policies and laws on the protection of vulnerable populations pay specific attention to the sexual and reproductive health needs and rights of internally displaced adolescents. This paper describes how a United Nations Population Fund (UNFPA)-supported programme (September 2000-August 2004) on the sexual and reproductive health of internally displaced adolescents contributed to restoring their dignity as a precursor to promoting their sexual and reproductive health rights. Different forms of the arts were used as basic techniques to discover their body and to provide sexual and reproductive health information and education. The arts were found to play a key role in restoring their dignity. Although dignity appeared to be a determinant of greater awareness of rights, it did not lead to increased empowerment with regard to rights. The availability of and access to sexual and reproductive health services remains a problem and displaced populations continue to have little or no power to hold their authorities accountable.
Dignity and the right of internally displaced adolescents in Colombia to sexual and reproductive health. Bosmans M, Gonzalez F, Brems E, Temmerman M.Disasters. 2012 Feb 13. doi: 10.1111/j.1467-7717.2012.01273.x. [Epub ahead of print]
Impact of financial and educational interventions on maternity care in rural China
This paper reports on the design and basic outcomes of three interventions aimed at improving the use and quality of maternity care in rural China.
Community-based cluster randomized trials were carried out in one central and two western provinces between 2007 and 2009: (1) financial interventions covered part of women's costs for prenatal and postnatal care, (2) training of midwives in clinical skills was given by local maternity care experts in two- or three-group training courses, (3) health education training for midwives and village doctors were given by local experts in health education in two- or three-group training courses. A survey was conducted in a stratified random sample of women who had been pregnant in the study period. 73% of women (n = 3,673) were interviewed within 1-10 months of giving birth. Outcomes were compared by the different intervention and control groups. Adjusted odds ratios were calculated by logistic regression to adjust for varying maternal characteristics. Most of the differences found between the groups were small and some varied between provinces. The financial intervention did not influence the number of visits, but was associated with increased caesarean sections and a decrease in many ultrasound tests. The clinical intervention influenced some indicators of care content. There was no consistent finding for the health education intervention. Financial and training interventions have the potential to improve maternity care, but better implementation is required. Unintended consequences, including overuse of technology, are possible.
Impact of Financial and Educational Interventions on Maternity Care: Results of Cluster Randomized Trials in Rural China, CHIMACA. Hemminki E, Long Q, Zhang WH, Wu Z, Raven J, Tao F, Yan H, Wang Y, Klemetti R, Zhang T, Regushevskaya E, Tang S. Matern Child Health J. 2012 Feb 23. [Epub ahead of print]