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From Albania to Zimbabwe: Surveying 10 Years of Summer Field Experiences at the Rollins School of Public Health.
Global Health: Science and Practice. 2017 Sep 27; 5(3):468-475.The objective of this article is to describe summer field experiences at the Rollins School of Public Health. An online survey was conducted among Master of Public Health students returning from summer field experiences. We used printed reports from 2004-2012 and original survey data from 2010-2013 to perform a trend analysis using correlation analysis and linear regression. We found that our students have worked for more than 300 organizations in 84 countries. The average cost of a summer field experience fluctuated around US$3,500, with students receiving an average of US$2,180 in funding. About 50% of students conducted human subjects research. This survey was used to improve student practical experiences through information sessions for students and feedback to key constituents, including the Emory Institutional Review Board and the Emory Travel Clinic.
Social and traditional practices and their implications for family planning: a participatory ethnographic study in Renk, South Sudan.
Reproductive Health. 2017 Jan 17; 14(1):10.BACKGROUND: Understanding what determines family size is crucial for programmes that aim to provide family planning services during and after conflicts. Recent research found that development agents in post conflict settings do not necessarily take time to understand the context adequately, translate their context understanding into programming, or adjust programming in the light of changes. South Sudan, a country that has been suffering from war for almost 50 years, has one of the highest maternal death rates and the lowest contraceptive utilization rates in the world. METHODS: This research used Participatory Ethnographic Evaluation and Research (PEER) to provide a contextualised understanding of social and traditional practices and their implications for family planning. Fourteen women were recruited from 14 villages in Renk County in South Sudan in the period 2010-2012. They were trained to design research instruments, conduct interviews, collect narratives and stories and analyse data to identify, prioritize and address their maternal health concerns. RESULTS: As a result of wars, people are under pressure to increase their family sizes and thus increase the nation's population. This is to compensate for the men perished in war and the high child death rates. Large family size is regarded as a national obligation. Women are caught up in a vicious cycle of high fertility and a high rate of child mortality. Determinants of large family size include: 1) Social and cultural practices, 2) Clan lineage and 3) Compensation for loss of family members. Three strategies are used to increase family size: 1) Marry several women, 2) Husbands taking care of women, and 3) Financial stability. Consequences of big families include: 1) Financial burden, 2) Fear of losing children, 3) Borrowing children and 4) Husband shirking responsibility. CONCLUSION: The desire to have a big family will remain in South Sudan until families realise that their children will live longer, that their men will not be taken by the war, and that the costs of living will be met. In order to generate demand for family planning in South Sudan, priority should be given first to improve infant and child health.
A general measles vaccination campaign in urban Guinea-Bissau: Comparing child mortality among participants and non-participants.
Vaccine. 2017 Jan 3; 35(1):33-39.Background Measles vaccination campaigns targeting children aged 9–59 months are conducted every three years in Guinea-Bissau. Studies have demonstrated beneficial non-specific effects of measles vaccine. We compared mortality one year after the December 2012 measles vaccination campaign in Bissau city for children who received campaign measles vaccine with children who did not receive campaign measles vaccine. Methods Field workers from Bandim Health Project registered all children living in the Bandim Health Project's study area who received measles vaccination at the campaign posts. Children not seen during the campaign were visited at home and campaign participation status was assessed. We compared mortality rates of participants vs. non-participants in Cox regression models. Results 5633 children aged 9–59 months (85%) received campaign measles vaccination and 1006 (15%) did not. During the subsequent year 16 children died. Adjusted for background factors, the hazard ratio (HR) comparing measles vaccinated versus unvaccinated was 0.28 (95% CI: 0.10–0.77). The benefit was larger for girls (HR: 0.17 (0.05–0.59)) and for children who had received routine measles vaccine before the campaign (HR: 0.15 (0.04–0.63)). Conclusions We found indications of strong beneficial non-specific effects of receiving measles vaccine during the 2012 campaign, especially for girls and children with previous routine measles vaccination. Measles vaccination campaigns may be an effective way of improving child survival.
HC3 uses technology in Bangladesh to build field worker confidence and social and behavior change communication skills.
[Baltimore, Maryland], HC3, . 7 p. (SBCC Capacity Strengthening in Action: HC3 Country Case Study Series)This case study examines the Bangladesh Knowledge Management Initiative (BKMI) project’s second phase, a three-year project (2013-2016), which focused on strengthening the capacity of the Bangladesh Ministry of Health and Family Welfare (MoHFW) at the individual, organizational and system levels.
[Washington, D.C., Cracking the Nut Health 2016], 2016. 28 p.The learning event, Cracking the Nut Health: The Role of Communities in Building Resilient Health Systems took place July 18-19, 2016 in Washington, D.C., which focused on the three core themes: 1) Using Measurement and Analytics to Improve Accountability; 2) Leveraging Partnerships to Promote Resilience; and 3) Scaling Technology and Innovation to Increase Impact.
Using community informants to estimate maternal mortality in a rural district in Pakistan: a feasibility study.
Journal of Pregnancy. 2015; 2015:267923.BACKGROUND: We aimed to assess the feasibility of using community-based informants' networks to identify maternal deaths that were followed up through verbal autopsies (MADE-IN MADE-FOR technique) to estimate maternal mortality in a rural district in Pakistan. METHODS: We used 4 community networks to identify deaths in women of reproductive age in the past 2 years in Chakwal district, Pakistan. The deaths recorded by the informants were followed up through verbal autopsies. RESULTS: In total 1,143 Lady Health Workers (government employees who provide primary health care), 1577 religious leaders, 20 female lady councilors (elected representatives), and 130 nikah registrars (persons who register marriages) identified 2001 deaths in women of reproductive age. 1424 deaths were followed up with verbal autopsies conducted with the relatives of the deceased. 169 pregnancy-related deaths were identified from all reported deaths. Through the capture-recapture technique probability of capturing pregnancy-related deaths by LHWs was 0.73 and for religious leaders 0.49. Maternal mortality in Chakwal district was estimated at 309 per 100,000 live births. CONCLUSION: It is feasible and economical to use community informants to identify recent deaths in women of reproductive age and, if followed up through verbal autopsies, obviate the need for conducting large scale surveys.
Maximizing the nutritional impact of food security and livelihoods interventions: a manual for field workers.
Montreal, Canada, ACF - International, 2011.  p.This manual aims to provide practical guidance to field workers in order to maximise the nutritional impact of food security & livelihoods (FSL) interventions. This requires the systematic use of a "nutrition lens" at each step of the project cycle and a close collaboration between sectors.
Evolving friendships and shifting ethical dilemmas: fieldworkers' experiences in a short term community based study in Kenya.
Developing World Bioethics. 2013 Apr; 13(1):1-9.Fieldworkers (FWs) are community members employed by research teams to support access to participants, address language barriers, and advise on culturally appropriate research conduct. The critical role that FWs play in studies, and the range of practical and ethical dilemmas associated with their involvement, is increasingly recognised. In this paper, we draw on qualitative observation and interview data collected alongside a six month basic science study which involved a team of FWs regularly visiting 47 participating households in their homes. The qualitative study documented how relationships between field workers and research participants were initiated, developed and evolved over the course of the study, the shifting dilemmas FWs faced and how they handled them. Even in this one case study, we see how the complex and evolving relationships between fieldworkers and study participants had important implications for consent processes, access to benefits and mutual understanding and trust. While the precise issues that FWs face are likely to depend on the type of research and the context in which that research is being conducted, we argue that appropriate support for field workers is a key requirement to strengthen ethical research practice and for the long term sustainability of research programmes. (c) 2013 Blackwell Publishing Ltd.
Bethesda, Maryland, Abt Associates, Strengthening Health Outcomes through the Private Sector [SHOPS], 2013 Mar.  p.The SHOPS project worked with Marie Stopes Madagascar to implement a year-long program (October 2010 to September 2011) in Madagascar that aimed to (1) expand access to voluntary family planning through provision of long-acting and permanent methods via mobile outreach teams working across underserved regions and (2) increase the demand for quality reproductive health services by removing financial barriers through vouchers. This program profile presents the program context, goals, components, results, and the following lessons learned: Public-private partnership was key to increasing the use of LA/PMs through outreach; Implants were the preferred method in outreach and voucher programs; Strong demand creation was crucial to the success of the outreach and voucher programs; Vouchers, when properly targeted, do not displace non-voucher clients; For voucher programs, it is imperative to put robust monitoring and fraud controls in place to limit and avoid collusion and overcharging to clients.
Health Promotion Practice. 2011 Sep; 12(5):734-43.The value of collaborative international research in addressing global public health challenges is increasingly recognized. However, little has been written about lessons learned regarding fieldwork to help guide future collaborative efforts. Through a research partnership between two Northern universities, one Southern university, and a Southern faith-based organization, we evaluated a school-based HIV prevention intervention with South African adolescents. In this article, we highlight the seven key fieldwork-related challenges experienced and identify the lessons learned. The underlying theme is that of reconciling a structured and reasoned "desk" planning process with the more fluid and unpredictable reality of conducting fieldwork. This concern is particularly significant in resource-deprived environments and/or contexts that are less familiar to Northern partners. Fieldwork is unpredictable, but obstacles can be minimized through meaningful participation in both planning and field research. Sharing practical lessons from the field can prove a useful resource for both researchers and practitioners.
Arlington, Virginia, John Snow [JSI], DELIVER, 2009 May. 3 p.USAID | DELIVER PROJECT staff member Sylvia Ness gives a first hand account of the importance of Logistics Support Officers in Bangladesh.
International Family Planning Perspectives. 2008 Sep; 34(3):151.Women's lack of access to legal abortion is a major contributing factor to high rates of worldwide maternal mortality and morbidity. This article describes changes in the legal status of abortion in countries around the world since 1998. METHODS: The complete texts of new abortion legislation, most often obtained directly from government Web sites, were reviewed to determine changes. Background information was, where possible, also based on a review of complete legal texts. Other sources include the International Digest of Health Legislation (published by the World Health Organization) and Abortion Policies: A Global Review (published in 2002 by the Population Division of the United Nations). RESULTS: Since 1998, 16 countries have increased the number of grounds on which abortions may be legally performed; in two other countries, state jurisdictions expanded grounds for abortion. Two countries have removed grounds for legal abortion. Other countries maintained existing indications for abortion but adopted changes affecting access to the procedure. CONCLUSIONS: The worldwide trend toward liberalization of abortion laws observed in 1998 has continued. Recognition of the impact of abortion restrictions on women's human rights has played an increasing role in efforts to provide access to abortion.
Gender and Development. 2007 Mar; 15(1):81-93.Violence against children is a global phenomenon. During humanitarian crises, and armed conflict in particular, the potential for gender-based violence (GBV), including sexual exploitation, increases. Children, particularly adolescent girls, are vulnerable. This article traces the impact of an expose´ of sexual abuse by humanitarian workers on the wider protection policies and practices of Save the Children UK. The article concludes that awareness of gender discrimination must underpin the implementation of protection policies for all children and their carers. Furthermore, it proposes that comprehensive responses to GBV must be devised, alongside prevention strategies, if children are to be effectively protected. (author's)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Jan; 102(1):20-24.To improve practical, accurate diagnosis of malaria in the Amazon rainforest of Venezuela, two rapid diagnostic tests (RDT) (OptiMAL-IT and FalciVax) and a laboratory light microscope, used in the field with a battery-operated head lamp as an external light source, were evaluated against the standard laboratory microscope procedure for malaria detection. One hundred and thirty-six Yanomami patients were studied for the presence of malaria parasites. Thirty-three patients (24%) were positive for malaria (Plasmodium falciparum, P. vivax, P. malariae). Twenty-one (64%) of the positive patients had less than 100 parasites/microl. Both RDTs showed poor sensitivity (24.2% for OptiMAL-IT and 36.4% for FalciVax) but good specificity (99% both for OptiMAL-IT and FalciVax). Field and laboratory microscopy showed sensitivities of 94% and 91%, respectively. The k coefficient was 0.90, indicating a high agreement between field and laboratory microscopy. We conclude that (i) adequate slide reading cannot be substituted by either of the two RDTs in the Venezuelan Amazon and (ii) the use of a light source such as that described above makes slide reading more feasible than hitherto in remote areas without electricity. (author's)
Assessment of three new parasite lactate dehydrogenase (pan-pLDH) tests for diagnosis of uncomplicated malaria.
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Jan; 102(1):25-31.A study to assess the diagnostic capabilities of three parasite lactate dehydrogenase (pan-pLDH) tests, Vistapan, Carestart and Parabank, was conducted in Uganda. An HRP2 test, Paracheck-Pf, and a Giemsa-stained blood film were performed with the pLDH tests for outpatients with suspected malaria. In total, 460 subjects were recruited: 248 with positive blood films and 212 with negative blood films. Plasmodium falciparum was present in 95% of infections. Sensitivity above 90% was shown by two pLDH tests, Carestart (95.6%) and Vistapan (91.9%), and specificity above 90% by Parabank (94.3%) and Carestart (91.5%). Sensitivity decreased with low parasitaemia (x/2 trend, P less than 0.001); however, all tests achieved sensitivity greater than 90% with parasitaemia greater than or equal to 100/microl. All tests had good inter-reader reliability (k greater than 0.95). Two weeks after diagnosis, 4-10% of pLDH tests were still positive compared with 69.7% of the HRP2 tests. All tests had similar ease of use. In conclusion, two pLDH tests performed well in diagnosing P. falciparum malaria, and all pLDH tests became negative after treatment more quickly than the HRP2. Therefore the rapid test of choice for use with artemisinin-combination therapies in this area would be one of these new pLDH tests. (author's)
Atlanta, Georgia, CARE, 2007. 109 p. (USAID Cooperative Agreement No. HRN-A-00-99-00009-00)As development workers, we know that good health is a necessary condition for helping people rise from poverty. We also know that poverty, and the social disadvantages usually associated with it, profoundly influence people's ability to stay healthy. For those of us whose careers have been spent working in communities around the world, the relationship between poverty, power and poor health is painfully clear. But have we done enough to address that relationship in our health programming? Much of our health work has sought to improve the availability of high-quality health information and services for poor women, men and young people. The thinking behind this approach was that good information and easily accessible services would enable people to make positive healthcare decisions and act upon them. This approach has worked up to a point. Decades of government and NGO efforts in the areas of prevention, health promotion and healthcare provision have undoubtedly led to better health for many poor people. Yet the shortcomings of our efforts are equally evident. Many intended beneficiaries never receive services, while others do not make decisions that could keep them healthy, despite access to sound information and health centers offering high-quality services. In other places, extensive investments in capacity building have not resulted in sustained improvements in health service delivery. (excerpt)
[London, England], International Institute for Environment and Development, 2005 Mar. 10 p. (Power Tools)People's Law describes how natural resource rights campaigners can better understand and use the legal systems in their campaigns. We propose how campaigners can: empower themselves by demystifying the legal system; develop an understanding of the laws that affect natural resources; and integrate law-focused action into campaign strategy People's Law reflects in part the experiences of organisations who joined hands to campaign for forestry governance reforms in Ghana as "Forest Watch Ghana" in 2004. (excerpt)
Dublin, Ireland, FrontLine International Foundation for the Protection of Human Rights Defenders, 2007 Feb.  p.This manual is divided into four parts which can be read in any order. The reader does not require any special expertise, although some basic knowledge of computer and Internet operations would come handy. The chapters, containing information of a more technical nature, are marked 'For Techies'. The First Section is about understanding your security needs and vulnerabilities. It describes a non-technical approach to the digital environment. A method of mapping the threats, posed by a particular situation, is offered to help you decide on the strategies for implementing privacy and security solutions. The Second Section lists various elements of computer and Internet security. It introduces the reader to computer operations and Internet infrastructure. Methods of securing data, bypassing Internet censorship and protecting yourself against malicious attacks are explained in detail. The Third Section is a summary of worldwide legislation to restrict and monitor information flow and communications. Itshows the downward trend, caused by the growth of restrictions to the rights to freedom of expression, privacy and communication, in many countries. Cases of human rights defenders currently in prison or persecuted because of their work through the Internet are presented as examples of the ways some governments enforce these pieces of legislation. The Fourth Section drafts possible scenarios for human rights defenders and their organisations of dealing with problems of electronic insecurity and ensuring continuation of their work. The scenarios relate to the concepts p resented throughout the book and solutions are based on realisable actions. (excerpt)
Collaborating with traditional healers for HIV prevention and care in sub-Saharan Africa: suggestions for programme managers and field workers.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2006 Nov. 54 p. (UNAIDS Best Practice Collection; UNAIDS/06.28E)Previous research and documents have identified initiatives that involved traditional healers in Africa and have described case studies and outlined their successes and failures. This present guide illustrates by means of clearly defined steps how successful collaborative projects have worked, and how lessons that have been learnt can be used to initiate new collaborations or expand existing ones. More specifically, this document aims to: identify the critical determinants of success and failure of documented collaborative initiatives; define a model strategy that can be adapted to reach out to traditional healers, and set up or scale up collaborations with the traditional health sector in sub-Saharan Africa; and document key necessary steps to build trust among traditional healers and biomedical health practitioners, impart critical information, and learn from, support and empower each other, as well as to monitor the collaboration and to evaluate successes and failures. (author's)
The implications of long term community involvement for the production and circulation of population knowledge.
Demographic Research. 2007 Nov 27; 17(13):369-388.Demographic surveillance systems (DSS) depend on community acceptance and involvement to produce high quality longitudinal data. Ensuring community support also exposes power relations usually concealed in the research process. We discuss the Agincourt Health and Demographic Surveillance System in South Africa to argue that: 1) long-term presence and community involvement contribute to high response rates and data quality, 2) to maintain community support the project must demonstrate its usefulness, 3) reporting to community members provides valuable checks on the local relevance and comprehension of questions, and 4) community opinion can modify both wording and content of research questions. (author's)
[Harare], Zimbabwe, Catholic Relief Services [CRS], 2007. 62 p. (How-to Guide)This Guide begins by summarizing the work of the CRS/Zimbabwe country program so that you have an understanding of how this program operates and how we are connected to the examples explored in this Guide. Then, it provides an overview of the concept of child participation, explaining why child participation is so important and providing guidance on how to analyze and evaluate the scope and level of child participation in a project. Next, the Guide offers six examples of how CRS/ Zimbabwe partner organizations facilitate child participation in their education initiatives. Each example includes relevant background information on the partner's programming; the specifics of how the partner organization facilitates child participation; a description of the critical steps organizations need to follow to facilitate child participation in a similar way; and an activity that can get you started on the road to child participation in your organization's education initiative. Please note that the guide is inno way comprehensive-there are literally hundreds of ways your organization could facilitate child participation in education activities. The examples provided here are ideas that hopefully will get you thinking about the many and varied ways that children access their participation rights and strategies you could use in your own context. (excerpt)
Chapel Hill, North Carolina, IntraHealth International, PRIME, 2003 Nov.  p. (PRIME PAGES: RR-26; USAID Grant No. HRN-A-00-99-00022-00)Like many large USAID global projects, PRIME II is designed for implementation by a consortium of partners who bring a broad set of complementary skills and capacities rarely available from a single organization. This is a strategy with many advantages, but it creates a complex structure to lead and manage. From the earliest stages of forming a partnership, responding to the Request for Application and the startup of operations, the five PRIME partner organizations have shared a powerful vision of the partnership in action. The resulting collaboration has proven unusually rewarding, and a review of its successes and lessons learned is provided here. Composed of two senior leaders from each partner organization, the Partner Leadership Group (PLG) provides a stable and consistent mechanism for direct participation in the Project's strategic direction and technical leadership. This tight-knit group meets four times a year, rotating venues among partner offices. These leaders must set the example of a willingness to prioritize the common good of the Project and to seek win-win decisions. (excerpt)
Bangladesh: responsive training and learning. The Health and Population Sector Programme (HPSP). Creating change from within.
Chapel Hill, North Carolina, IntraHealth International, PRIME, 2003 Nov.  p. (PRIME PAGES: RR-38; USAID Grant No. HRN-A-00-99-00022-00)At the request of USAID/Dhaka, the PRIME II Project worked with the Bangladesh Ministry of Health and Family Welfare to implement a national in-service training strategy for the essential services package (ESP). The PRIME I Project had been instrumental in drafting Bangladesh's national strategy, so the follow-on PRIME II Project was ideally positioned for this activity and established an office within the Technical Training Unit (TTU) of the Ministry, which worked side-by-side with the TTU staff for three years (2000-2003). PRIME's goals were to help the TTU operationalize the national in-service training strategy and to create a decentralized national system to train 54,000 primary providers. Key objectives included: Strengthen central-level management capacity; Standardize in-service planning, implementation and follow-up; Strengthen lead training organization (LTO) capacity; Strengthen district and sub-district (upazila) capacity to plan and monitor training; Conduct training and follow-up; Develop monitoring and evaluation capability at the central level, including a Training Management Information System. (excerpt)
The power of AIDS: kinship, mobility and the valuing of social and ritual relationships in Tanzania.
African Journal of AIDS Research. 2006 Sep; 5(2):109-121.The HIV/AIDS epidemic in Africa has become a test case of the effects of globalisation, in that it demonstrates how international processes may affect regional life situations and how 'the local' can simultaneously develop in its own way, through the processes of appropriating, modifying, and resisting global influences. Drawing on fieldwork in Tanzania, I show how the Luo in the Mara region define HIV/AIDS as an outcome of modernity and globalisation, which to them have become embodied in processes of migration, the collapse of generational and gender hierarchies, and an increased immorality in contemporary society. While social and moral ruptures in Mara become further condensed in tensions between lineages and AIDS-sick relatives, mourning and burial rituals (including widow cleansing), disputes over inheritance rights, and the attribution of illness to the breaking of a taboo (chira) have become essential for negotiating and maintaining social and cultural relationships in an era of AIDS. In conclusion I argue that the concepts of vitality and moral practice may assist an understanding of how different social actors in sub-Saharan Africa have responded to the breakdowns associated with increased suffering and death, and to describe some social and moral developments observable in the context of internationally driven public health campaigns in the region. (author's)
Weighing Vietnamese children: How accurate are child weights adjusted for estimates of clothing weight?
Food and Nutrition Bulletin. 2002; 23 Suppl 4:45-49.Children who are weighed for growth monitoring are frequently clothed, especially in the cold weather. Health workers commonly estimate and subtract the weight of these clothes, but the accuracy of these estimates is unknown. We assessed the accuracy of child weights adjusted for estimated clothing typical of hot, cold, and extremely cold ambient temperatures. Trained field workers weighed a sample of 212 children 6 to 42 months old from the ViSION project, adjusted the weights using a job aid describing the weights of common clothing by season and age, and then weighed the clothing to calculate the actual clothing and child weights. Fieldworker estimates of the weight of the clothing that children wore during weighing were remarkably good. In nearly all cases (207 of 212; 97.7%), the difference between the estimated and actual clothing weight was less than the precision of the child scales (± 50 g), and most (181 of 212; 84.5%) were within 25 g. Thus, the calculated child weights were, in fact, equivalent to the actual child weights. Using simulations, we found that improperly accounting for clothing weight can overestimate weight-for-age by 0.1 to 0.4 Z score. Accurate weights are possible, even under adverse conditions. Our training methods, clothing album, and job aid might benefit nutrition research and programming in Viet Nam as well as settings with colder climates. (author's)