Newsletter May 2014
| ICRH Global Newsletter |
28th of May, 2014
HIV prevention interventions targeting sex workers and their clients in Kenya
ICRH is a partner in a newly started 3-years study testing the feasibility of implementing venue-based HIV prevention interventions, targeting sex workers (SWs) and their clients, in Coast Province, Kenya.
The study will develop and pilot a multi-level intervention in nightclubs/bars in Mombasa. In phase 1, we will assess the socio-cultural context of risk behavior, beliefs/understandings of HIV and risk; barriers to and facilitators of risk-reduction; and responses to intervention messages through in-depth interviews among SWs and clients. In phase 2, we will design a multi-level risk-reduction intervention tailored to the local context, that includes peer-delivered individual and group education, distribution of male and female condoms and lubricants, “street theater” presentations, on-site “moonlight” HIV testing and counseling and STI care, and manager meetings in Mombasa bars and nightclubs. In phase 3, we will test the intervention package for feasibility, acceptability, as well as participant level of exposure and intervention contamination at control sites via process measures, and test the feasibility of an intervention evaluation design to be used in a future study. The study is financed by a R01 grant of the National Institute for Health (NIH) of the United States and lead by the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University. ICRH-Kenya will coordinate and implement the study on site, and ICRH-Belgium, together with Stat-Gent CRESCENDO of the University Ghent, will take the lead in the design and coordination of phase 3.
Field visits in Burkina Faso and Kenya for the MOMI project
In the course of April 2014, Els Duysburgh and Aurore Guieu visited the sites of Kwale (Kenya) and Kaya (Burkina Faso) together with the ICRH-Kenya and IRSS local teams.
ICRH-Mozambique’s night clinics in Tete province
ICRH has been implementing sexual and reproductive health activities in Tete city, Mozambique targeting female sex workers and long distance truck drivers (LDTD) since 2002.
Opening ceremony night clinic, February 2013.
Night clinic Moatize
MoU with Women’s Global Network for reproductive Rights
5th EUPHA European Conference on Migrant and Ethnic Minority Health
Between April 9-12th, Ines Keygnaert and Aurore Guieu travelled to Granada, Spain, to attend the 5th EUPHA European Conference on Migrant and Ethnic Minority Health hosted by the Andalusian School of Public Health.
FGM Reference centre established at Ghent University Hospital
The centre, which was launched 8 May 2014, will provide medical and psychological guidance and treatment to girls of 14 years and older who are victim to FGM.
May 28: International Day of Action for Women’s Health, Women’s Rights Defenders
In commemoration of 30 years of struggle and activism, women’s rights defenders and activists worldwide are re-launching May 28, the International Day of Action for Women’s Health.
|ICRH - PEOPLE|
Dr. Rita Verhelst is leaving ICRH after having worked for many years at Ghent University as a biotechnologist with specialization in medical molecular microbiology and virology.
Rita started working for Ghent University in 1994 at the AIDS reference laboratory. In 2000, after a 3-years stay at Innogenetics, she returned to Ghent University to pursue a PhD in medical molecular microbiology. As a post-doctoral researcher at ICRH the focus of Rita’s research was on the characterization of the cervicovaginal microbiome and STI diagnostics. Rita leaves ICRH to pursue new career opportunities.
More information: firstname.lastname@example.org
Beatrice joined ICRH Mozambique as its first Country Director in 2011. Under her leadership, the organization has grown substantially over the past 3 years, both in number of projects and staff, while at the same time she had the challenging task of developing all organizational and management tools needed in running the association. She was also instrumental in developing ICRH-M’s first Strategic Plan. Besides leading and representing the organization, Beatrice was directly in charge of the implementation of the project “A demonstration project for the implementation of the WHO antenatal care model in Mozambique: A cluster randomized controlled trial”.
Sally has a Masters in Reproductive and Sexual Health Research from the London School of Hygiene & Tropical Medicine, with a dissertation on “Determinants of condom use by sex workers in Nepal with clients and other sexual partners: A quantitative study”. She has over 15 years of experience working in the area of sexual and reproductive health and rights, mainly in Mozambique and Angola. This has included experience working in both senior management and technical positions.
Gilda joined ICRH Mozambique in 2011. With her social sciences background, and as holder of a Master in Public Health, she was mainly responsible for the coordination and implementation of the projects in the area of Maternal and Child Health, more specifically the EU funded project “MOMI - Missed Opportunities in Maternal and Child Health” and other projects with DANIDA, UNICEF funding in Tete province, and more recently also giving support to a Family Planning project in Maputo province. Gilda leaves ICRH to pursue new career opportunities.
Guidelines on contraception and human rights
History of Abuse and Operative Delivery
Lactobacillus-dominated cervicovaginal microbiota, HIV/STI prevalence and genital HIV viral load in African women.
|The incidence and severity of community assault in Khayelitsha, South Africa|
Anecdotal evidence suggests that victims of community assault (CA) are worse off than other assault cases, but scientific data on the rate and severity of CA cases are lacking for SA.
Therefore a case count study was conducted to estimate the rate of CA among adults in Khayelitsha and comparing the injury severity and survival probability between cases of CA and other assault (non-CA) cases. A consecutive case series was conducted in four healthcare centres in Khayelitsha during July - December 2012 to capture all CA cases during this period. A retrospective folder review was performed on all cases of CA and on a control group of non-CA cases to compare injury severity and estimate survival probability. A total of 148 adult cases of CA occurred over the study period. Based on an estimate population of 275,300 adults in Khayelitsha of ≥18 years, the rate of adult cases of CA that received healthcare in Khayelitsha was 1.1/1,000 person-years. For non-CA, the estimated rate was 19/1,000 person-years. The Injury Severity Scores in the CA group were significantly higher than in the non-CA group (p<0.001), with a median Injury Severity Score of 3 in CA cases versus 1 in non-CA cases. Comparison between the CA and non-CA groups showed that a Glasgow Coma Scale <15 (20.1% versus 5.4%, respectively), referral to the tertiary hospital (33.8% versus 22.6%, respectively), and crush syndrome (25.7% versus 0.0%, respectively) were all more common in CA cases. Survival probabilities were similar in both groups.
This study confirms that the rate of CA among adults in Khayelitsha is high, and the severity of injuries sustained by CA victims is substantially higher than in other assault cases. The findings beg for multi-sectoral action to curb the medical and social consequences of assault in SA. Furthermore, social science research is needed to improve our understanding of the psychology and sociology behind CAs and to develop evidence-led prevention strategies, the feasibility and effectiveness of which also require further investigation.
Sheron Forgus, Wim Delva, Christine Hauptfleisch, Srini Govender, Julia Blitz. The incidence and severity of community assault in Khayelitsha, South Africa. S Afr Med J 2014;104(4):299-301. DOI:10.7196/SAMJ.7615
|Pregnancy outcomes in Libya before and during the armed conflict|
Stressful life events experienced by pregnant women may lead to adverse obstetric outcomes.
This study in Benghazi, Libya compared the rates of preterm, low-birth-weight and caesarean-section births at Al-Jamhouria hospital in the months before and during the armed conflict in Libya in 2011. Data were collected on all women admitted to the delivery ward during February to May 2011 (the months of the most active fighting in the city) (n= 7096), and October to December 2010 (the months immediately before the war) (n = 5935). Compared with the preceding months there was a significant rise during the conflict in the rate of deliveries involving preterm (3.6% versus 2.5%) and low-birth-weight (10.1% versus 8.5%) infants and caesarean sections (26.9% versus 25.3%). Psychosocial stress may have been a factor (among others) in an increase in negative pregnancy outcomes, and
obstetric hospitals should be aware of these issues in times of war.
Z. Bodalal, K. Agnaeber, N. Nagelkerke, B. Stirling, M. Temmerman and O. Degomme. Pregnancy outcomes in Benghazi, Libya, before and during the armed conflict in 2011. EMHJ, Vol. 20 No. 3, 2014 Eastern Mediterranean Health Journal, La Revue de Santé de la Méditerranée orientale.
|Spousal discordance on fertility preference|
This study assesses the effect of spousal agreement levels regarding fertility preference and spousal communication on contraceptive practice among married couples in Jimma zone, Ethiopia.
Quantitative data were collected in a cross-sectional study from March to May 2010 in Jimma
zone, Ethiopia, using a multistage sampling design covering six districts. In each of the 811 couples included in the survey, both spouses were interviewed. Concordance between the husband and wife was assessed using different statistics and tests including concordance rates, ANOVA, Cohen’s ? and McNemar’s test for paired samples. Multivariate analysis was computed to ascertain factors associated with contraceptive use.
Over half of the couples wanted more children and 27.8% of the spouses differed about the desire for more children. In terms of sex preference, there was a 48.7% discord in couples who wanted to have more children. At large, spousal concordance on the importance of family planning was positive. However, it was the husband’s favourable attitude towards family planning that determined a couple’s use of contraception. Overall, contraceptive prevalence was 42.9%. Among the groups with the highest level of contraceptive users, were couples where the husband does not want any more children. Spousal communication about the decision to use contraception showed a positive association with a couple’s contraceptive prevalence.
The authors conclude that family planning programs aiming to increase contraceptive uptake could benefit from findings on spousal agreement regarding fertility desire, because the characteristics of each spouse influences the couple’s fertility level. Disparities between husband and wife about the desire for more children sustain the need for male consideration while analysing the unmet need for contraception. Moreover, men play a significant role in the decision making concerning contraceptive use. Accordingly, involving men in family planning programs could increase a couple’s contraceptive practice in the future.
Tizta Tilahun, Gily Coene, Marleen Temmerman and Olivier Degomme. Spousal discordance on fertility preference and its effect on contraceptive practice among married couples in Jimma zone, Ethiopia. Reproductive Health 2014, 11:27. http://www.reproductive-health-journal.com/content/11/1/27
|‘Sexual health is dead in my body”|
This paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexual health determinants.
Although migrants constitute an important proportion of the European population, little is known
about migrant sexual health. Existing research mainly focuses on migrants’ sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided.
Applying Community-based Participatory Research as the overarching research approach, the au-thors conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands.
The results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Furthermore, results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health. Conclusion: Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands should be granted the same opportunity as Belgian and Dutch citizens have, to become equally in control of their sexual health and sexuality.
Ines Keygnaert, Nicole Vettenburg, Kristien Roelens and Marleen Temmerman. Sexual health is dead in my body: participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. BMC Public Health 2014, 14:416. http://www.biomedcentral.com/1471-2458/14/416
|Efficiency of antenatal care and childbirth services in in rural Tanzania|
A cross-sectional study aimed at assessing the costs of providing antenatal care (ANC) and child-birth services in selected rural primary health care facilities in Tanzania.
In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. This retrospective quantitative cross-sectional study was conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described.
The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency.
The authors conclude that differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the per-formance results to gauge progress and reward efficiency through performance based incentives.
Saronga HP, Duysburgh E, Massawe S, Dalaba MA, Savadogo G, Tonchev P, Dong H, Sauerborn R, Loukanova S. Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study. BMC health services research 2014, 14(1):96.