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The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis.
PloS One. 2018; 13(2):e0192910.BACKGROUND: Nearly a quarter of a million children have acquired HIV, prompting the implementation of new protocols-Option B and B+-for treating HIV+ pregnant women. While efficacy has been demonstrated in randomized trials, there is limited real-world evidence on the impact of these changes. Using longitudinal, routinely collected data we assessed the impact of the adoption of WHO Option B in Rwanda on mother to infant transmission. METHODS: We used interrupted time series analysis to evaluate the impact of Option B on mother-to-child HIV transmission in Rwanda. Our primary outcome was the proportion of HIV tests in infants with positive results at six weeks of age. We included data for 20 months before and 22 months after the 2010 policy change. RESULTS: Of the 15,830 HIV tests conducted during our study period, 392 tested positive. We found a significant decrease in both the level (-2.08 positive tests per 100 tests conducted, 95% CI: -2.71 to -1.45, p < 0.001) and trend (-0.11 positive tests per 100 tests conducted per month, 95% CI: -0.16 to -0.07, p < 0.001) of test positivity. This represents an estimated 297 fewer children born without HIV in the post-policy period or a 46% reduction in HIV transmission from mother to child. CONCLUSIONS: The adoption of Option B in Rwanda contributed to an immediate decrease in the rate of HIV transmission from mother to child. This suggests other countries may benefit from adopting these WHO guidelines.
Geneva, Switzerland, WHO, 2015. 124 p.The report delivers both promising and disappointing messages about the situation in low- and middle-income countries. Within-country inequalities have narrowed, with a tendency for national improvements driven by faster improvements in disadvantaged subgroups. However, inequalities still persist in most reproductive, maternal, newborn and child health indicators. The extent of within-country inequality differed by dimension of inequality and by country, country income group and geographical region. There is still much progress to be made in reducing inequalities in RMNCH.
Current Opinion In Obstetrics and Gynecology. 2015 Dec; 27(6):451-9.PURPOSE OF REVIEW: The purpose of this review is to revisit the inception of the WHO's medical eligibility criteria for contraceptive use (MEC), particularly its objectives and methodology, and to describe its impact over the last 20 years in the field of family planning. New recommendations are summarized from the newly released fifth edition of the guidance. RECENT FINDINGS: Fourteen topics, encompassing over 575 recommendations were reviewed for the MEC, fifth edition. New recommendations include: changes for combined hormonal contraceptive use among postpartum women; progestogen-only methods among breastfeeding women; and women at high risk for HIV infection, women living with HIV, and women living with HIV using antiretroviral therapy and hormonal contraception. New methods reviewed include subcutaneously administered depot medroxyprogesterone acetate, Sino-implant (II), ulipristal acetate, and progesterone-releasing vaginal ring. SUMMARY: Over the past 20 years, the MEC has become a remarkably influential document for practitioners and policy makers in family planning, as it provides up-to-date, evidence-based recommendations for contraceptive use for women with various medical conditions and medically relevant characteristics.
Contraception. 2011 Oct; 84(4):339-41.This editorial focuses on a strategy to expand contraceptive coverage through the development of a numerical International Statistical Classifications of Diseases (ICD) code for "unwanted fertility." It explains how this strategy would work, how to make the strategy happen through a revision process, and defining unwanted fertility as a medical problem. Copyright © 2011 Elsevier Inc. All rights reserved.
Commentary: Early antiretroviral therapy for HIV infection in sub-Saharan Africa, a challenging new step.
Journal of Public Health Policy. 2010 Dec; 31(4):401-6.Recent changes in guidelines (World Health Organization (WHO), USA, and likely Europe soon) all move towards earlier initiation of antiretroviral therapy in asymptomatic patients infected with human immunodeficiency virus (HIV). Sonia Menon appropriately questions the feasibility and consequences at both individual and community levels of the early initiation of antiretroviral therapy in sub-Saharan Africa as likely effects will be both positive and negative. Local context should drive the uptake process in every country. Money, national and international, will be essential for the successful implementation of the new WHO recommendation. Leaders at both levels must take their responsibilities and mobilize the necessary resources, for example, doubling those for the Global Fund to Fight AIDS, Tuberculosis and Malaria from $10 billion to $20 billion USD for 2011-2013.
Trends in maternal mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and The World Bank.
Geneva, Switzerland, World Health Organization [WHO], 2010.  p.This report presents the global, regional, and country estimates of maternal mortality in 2008, and the findings of the assessment of trends of maternal mortality levels since 1990. It summarizes the challenges involved in measuring maternal mortality and the main approaches to measurement, and explains the methodology of the 2008 maternal mortality estimates. The final section discusses the use and limitations of the estimates, with an emphasis on the importance of improved data quality for estimating maternal mortality. The appendices present the sources of data for the country estimates as well as MMR estimates for the different regional groupings for WHO, UNICEF, UNFPA, The World Bank, and UNPD. (Excerpt)
New York, New York, UNFPA, 2009. 94 p.Women bear the disproportionate burden of climate change, but have so far been largely overlooked in the debate about how to address problems of rising seas, droughts, melting glaciers and extreme weather, concludes The State of World Population 2009, released by UNFPA, the United Nations Population Fund. The poor are especially vulnerable to the effects of climate change, and the majority of the 1.5 billion people living on $1 a day or less are women. The poor are more likely to depend on agriculture for a living and therefore risk going hungry or losing their livelihoods when droughts strike, rains become unpredictable and hurricanes move with unprecedented force. The poor tend to live in marginal areas, vulnerable to floods, rising seas and storms. The report draws attention to populations in low-lying coastal areas that are vulnerable to climate change and calls on governments to plan ahead to strengthen risk reduction, preparedness and management of disasters and address the potential displacement of people. Research cited in the report shows that women are more likely than men to die in natural disasters-including those related to extreme weather -- with this gap most pronounced where incomes are low and status differences between men and women are high. The State of World Population 2009 argues that the international community's fight against climate change is more likely to be successful if policies, programmes and treaties take into account the needs, rights and potential of women. The report shows that investments that empower women and girls -- particularly education and health -- bolster economic development and reduce poverty and have a beneficial impact on climate. Girls with more education, for example, tend to have smaller and healthier families as adults. Women with access to reproductive health services, including family planning, have lower fertility rates that contribute to slower growth in greenhouse-gas emissions in the long run.
Atlanta, Georgia, CARE, 2005 Jun. 32 p. (Sexual and Reproductive Health Working Paper Series No. 1)In other words, keep digging below the surface. Getting rid of a thorny plant means digging right to the roots; it is not enough to just cut back the branches! But sometimes, fears of "getting it wrong" and other work pressures can leave staff unsure of how to deal with questions like: What do we really know about what is happening at field level? Do our project designs really achieve their intended effect? Why are we implementing projects this way? How do social and personal relationships in and around the project work? Who holds what power? Are we contributing enough to the creation of positive change in people's lives? How could we do more? These are not easy questions - and there are no simple answers. But by asking such questions throughout the project cycle, and looking for answers and amending work as a result, staff can increase project impact. Making one set of changes, however, is not enough. Staff must keep asking questions. Do the changes work? If so, who do they benefit? How? Where is the power now? Have inequities changed? And what else can be done to create greater change in people's lives? This approach is often referred to as "reflective learning," or learning by inquiry. It is closely linked with organizational learning. (excerpt)
International Journal of Health Planning and Management. 1998; 13:199-215.Although health care reforms have been implemented in both developed and developing countries since the 1980s, there has been little discussion of the historical, social and political contexts in which such reforms have taken place. Health care reforms in developing countries, for instance, have been an integral component of structural adjustment policies, yet scant attention has been paid to these connections nor to their implications. The basic assumptions behind the reforms, and in particular, the ideological underpinnings of health care reorganization, need to be taken into account when considering long-term strategies and policies to provide health services in developing countries. (author's)
Journal of Midwifery and Women's Health. 2005; 353.When the Bulletin of the World Health Organization dedicates an entire issue to health worker migration, it is a clear indication that the topic has global health significance. Buchan and Sochalski, recognized leading authorities on the subject of nurse migration, provide a descriptive overview of nurse migration patterns and core issues. They offer a detailed profile for 5 nursing workforce “destination” countries: Australia, Ireland, Norway, the United Kingdom, and the United States. By performing a comparative analysis, made possible by each country’s high-quality health system infrastructure and valid nursing workforce data, the authors have seized the opportunity to further examine this timely issue. (excerpt)
Population 2005. 2003 Jun; 5(2):1-4.The 2002 Revision of the official United Nations population estimates and projections, which has been issued recently, projects a world population of 8.9 billion in 2050 rather than 9.3 billion projected in the 2000 revision. About half of the 0.4 billion difference in these projected populations results from an increase in the number of projected deaths, the majority stemming from higher projected levels of HIV prevalence. The other half of the difference reflects a reduction in the projected number of births, primarily as a result of lower expected future fertility levels. Despite the lower fertility levels projected and the increased mortality risks to which some populations will be subject, the population of the world is expected to increase by 2.6 billion during the next 47 years, from 6.3 billion today to 8.9 billion in 2050. However, the realization of these projections is contingent on ensuring that couples have access to family planning and that efforts to arrest the current spread of the HIV/AIDS epidemic are successful in reducing its growth momentum. The potential for considerable population increase remains high. (excerpt)
AIDS Treatment News. 2003 Nov 28; (396): p..Three million people died of AIDS this year compared with 2.7 million last year, and five million were newly infected -- both more than ever before, according AIDS Epidemic Update: December 2003, compiled and published by UNAIDS, the United Nations Joint Programme on HIV/AIDS. Forty million people are now living with HIV, up slightly from last year. There is good news from a number of individual countries, as well as increased commitment from many governments, and increased total resources worldwide devoted to the epidemic. Some prevention programs have worked well. But many countries are at a critical stage where they could abort a major epidemic if they act now. Unfortunately some of their governments are still not serious about AIDS. (excerpt)
World population in 2300. Proceedings of the United Nations Expert Meeting on World Population in 2300, United Nations Headquarters, New York.
New York, New York, United Nations, 2004 Mar 24 x, 36 p. (ESA/P/WP.187/Rev.1)In order to address the technical and substantive challenges posed by the preparation of long-range projections at the national level, the Population Division convened two meetings of experts. The first meeting, the Technical Working Group on Long-Range Population Projections, was held at United Nations Headquarters in New York on 30 June 2003 and provided consultation on the proposed assumptions and methodology for the projection exercise. The second meeting, the Expert Meeting on World Population in 2300, was held at United Nations Headquarters on 9 December 2003. Its purpose was to examine the results of the long-range projections and to discuss lessons learned and policy implications. The Expert Group consisted of 30 invited experts participating in their personal capacity. Also attending were staff members of the Population Division and the Statistics Division, both part of the Department of Economic and Social Affairs of the United Nations Secretariat. This document presents the report of the meeting of the Expert Group on World Population in 2300, along with the background paper prepared by the Population Division and the questions addressed by the meeting. The Population Division drew valuable guidance from the deliberations at the meeting as well as from comments submitted in writing by the experts. All of these inputs will be taken into consideration in preparing the final report on the long-range projections, as well as in future projection exercises. The Population Division extends its appreciation to all the experts for their suggestions and contributions to the preparation of the long-range projections. (excerpt)
Perspectives in Health. 2003; 8(2):26-29.More and more, nurses in the Caribbean have been packing their bags and heading for countries with less-than-perfect climates to get better pay and more respect. Now the region is looking for ways to keep them from leaving – and even to lure those abroad back home. (author's)
[UN assistance in reinforcing African capacities in the area of human rights: the case of legislative reform and support for judicial power] L'Assistance de l'ONU pour le renforcement des capacités africaines dans le domaine des droits de l'homme: cas de la réforme législative et de l'appui au pouvoir judiciaire.
In: La protection des droits de l'Homme entre la législation interne et le droit international. Actes du colloque organisé par le Centre de Recherches sur la Coopération Internationale pour le Développement de la Faculté de Droit de Marrakech avec le concours de la Fondation Hanns-Seidel, les 21 et 22 janvier 2000. Rabat, Morocco, Revue Marocaine d'Administration Locale et de Developpement, 2001. 11-16. (Thèmes Actuels No. 26)In order to respect the main conventions currently in force, and the African Charter of Human and People Rights, the member countries must submit a report on the way they implement the tools supporting human rights, and on the obstacles they encounter. But for reasons linked to a lack of expertise and/or financial resources, many countries are lead to solicit assistance from foreign countries or international organizations such as the UN. This statement is particularly true for African countries. The assistance is mainly technical and is aimed at reinforcing the capacity of these states, and at integrating the norms pertinent to human rights in their judicial and legislative systems. The action of the UN is based on a normative, institutional and operational system, and for that purpose, African countries benefited from the Technical Cooperation Program (Programme de Coopération Technique). The consultative services program, once established, provides technical aid to help with obtaining grants, training through the organization of regional or national seminars, and the consultative services of experts for constitutional or legislative reforms. This program evolved; on one hand it opened up to embrace other domains; and, on the other hand, it opened technical cooperation offices on the field. As for the reinforcement of judicial power, the UN has proposed several strategies such as: constitutional and legislative reforms to reinforce the independence of the judicial power from other bodies of the State, judicial reforms, rehabilitation of the social status of judges and representatives of the law, and reinforcement of training. Furthermore, the Vienna Action Program, (Programme d'action de Vienne), adopted by the World Human Rights Conference of 1993, highlighted the financing of projects devoted to judicial protection and to the reinforcement of the independence of the judicial system of a few African countries.
Social Science and Medicine. 2003 Nov; 57(9):1547-1557.Spurred on by donors, a number of developing countries are in the midst of fundamental health and population sector reform. Focused on the performance-oriented norms of efficiency and effectiveness, reformers have paid insufficient attention to the process-oriented norms of sovereignty and democracy. As a result, citizens of sovereign states have been largely excluded from the deliberative process. This paper draws on political science and public administration theory to evaluate the Bangladeshi reform experience. It does so with reference to the norms of efficiency, effectiveness, sovereignty and democracy as a means of making explicit the values that need to be considered in order to make health and population sector reform a fair process. (author's)
Population and Development Review. 2002 Dec; 28(4):707-733.We begin by briefly describing the shift in population policies. We then set out two theoretical frameworks expected to account for national reactions to the new policy: first, the spontaneous spread of new cultural items and the coalescence of a normative consensus about their value, and second, the directed diffusion of cultural items by powerful Western donors. We then describe our data and evaluate its quality. Subsequently, we analyze the responses of national elites in our five study countries to the Cairo agenda in terms of discourse and implementation. In our conclusion, we evaluate these responses in terms of the validity of the two theoretical frameworks. (excerpt)
Africa Recovery. 2003 Jul; 17(2):10-11.Concern is growing among governments, policymakers and civil society groups that the international community is sidelining African priorities as it focuses on the crisis in Iraq. "My appeal to the main donors is that while they should attend to the reconstruction of Afghanistan and Iraq, Africa is also in dire need of resources to get rid of poverty, to be able to get safe water, to get education and so on;' Ugandan Finance Minister Gerald Ssendaula said during a recent visit to Washington, DC. UN Deputy Emergency Relief Coordinator Carolyn McAskie rein- forced these concerns at a New York press conference in May. Drawing attention to Africa's "forgotten emergencies," she recalled that last year international donor focus was on Afghanistan, before that Kosovo and now Iraq. (excerpt)
East African Medical Journal. 2003 Jun; 80(6 Suppl):S1-S20.Health sector reform is 'a sustained process of fundamental changes in national health policy, institutional arrangements, etc. guided by government and designed to improve the functioning and performance of the health sector and, ultimately, the health status of the population'. All the forty six countries in the African Region of the World Health Organisation have embarked on one form of health sector reform or the other. The contexts and contents of their health reform programmes have varied from one country to another. Health reforms in the region have been influenced largely by the poor performance of the health systems, particularly with regard to the quality of health services. Most countries have taken due congnizance of the deficiencies on their health systems in the design of their health reform programmes and they have made some progress in the implementation of such programmes. Indeed, some countries have adopted sector-wide approaches (SWAps) in developing and implementing their health reform programmes. Since countries are at various stages of implementing their health reform programmes, there is a lot of potential for countries to learn from one another. This paper is a synthesis of the experiences of the countries of the Region in the development and implementation of their health sector reform programmes, it also highlights the future perspectives in this important area. (author's)
Living well with HIV / AIDS: a manual on nutritional care and support for people living with HIV / AIDS.
Rome, Italy, FAO, 2002. vi, 97 p.The links between nutrition and infection are well known. Good nutrition is essential for achieving and preserving health while helping the body to protect itself from infections. Consumption of a well-balanced diet is essential to make up for the loss of energy and nutrients caused by infections. Good nutrition also helps to promote a sense of well-being and to strengthen the resolve of the sick to get better. The nutritional advice in this manual can help sick people, including those living with HIV/AIDS, to feel better. Few crises have affected human health and threatened national, social and economic progress in quite the way that HIV/AIDS has. The pandemic has had a devastating impact on household food security and nutrition through its effects on the availability and stability of food, and access to food and its use for good nutrition. Agricultural production and employment are severely affected and health and social services put under great strain. Families lose their ability to work and to produce. With worsening poverty, families also lose their ability to acquire food and to meet other basic needs. Time and household resources are consumed in an effort to care for sick family members, partners may become infected, families may be discriminated against and become socially marginalized, children may be orphaned and the elderly left to cope as best they can. Meeting immediate food, nutrition and other basic needs is essential if HIV/AIDS-affected households are to live with dignity and security. Providing nutritional care and support for people living with HIV/AIDS is an important part of caring at all stages of the disease. This manual provides home care agents and local service providers with practical recommendations for a healthy and well-balanced diet for people living with HIV/AIDS. It deals with common complications that people living with HIV/AIDS experience at different stages of infection and helps provide local solutions that emphasize using local food resources and home-based care and support. (excerpt)
Health Policy and Planning. 2003; 18(3):249-260.India’s health system was designed in a different era, when expectations of the public and private sectors were quite different. India’s population is also undergoing transitions in the demographic, epidemiologic and social aspects of health. Disparities in life expectancy, disease, access to health care and protection from financial risks have increased. These factors are challenging the health system to respond in new ways. The old approach to national health policies and programmes is increasingly inappropriate. By analyzing interand intra-state differences in contexts and processes, we argue that the content of national health policy needs to be more diverse and accommodating to specific states and districts. More ‘splitting’ of India’s health policy at the state level would better address their health problems, and would open the way to innovation and local accountability. States further along the health transition would be able to develop policies to deal with the emerging epidemic of non-communicable diseases and more appropriate health financing systems. States early in the transition would need to focus on improving the quality and access of essential public health services, and empowering communities to take more ownership. Better ‘lumping’ of policy issues at the central level is also needed, but not in ways that have been done in the past. The central government needs to focus on overcoming the large inequalities in health outcomes across India, tackle growing challenges to health such as the HIV epidemic, and provide the much needed leadership on systemic issues such as the development of systems for quality assurance and regulation of the private sector. It also needs to support and facilitate states and districts to develop critical capacities rather than directly manage programmes. As India develops a more diverse set of state health policies, there will be more opportunities to learn what works in different policy environments. (author's)
The new lepers. HIV-positive people are treated as social outcasts while the government fails to cope.
London, England, Institute for War and Peace Reporting [IWPR], 2003 Aug 8. 3 p. (Belarus Reporting Service No. 28)More and more people in Belarus are finding themselves in her position – 50 or 60 new HIV cases are recorded every month. At the beginning of August, the number of people carrying the virus reached 5,150, and experts fear that the figure will be more than double that in 2005. More worryingly, some say the recorded figures should be multiplied by a factor of three or more since they fail to capture drug users who have not been seen by the health authorities. Although HIV and AIDS are advancing rapidly, neither the government nor society in general appear able to come to terms with it. A survey conducted jointly by the United Nations and the Centre for Sociological and Political Research in Minsk found that three quarters of the people polled thought people with HIV should not be allowed to care for their own children, and more than 40 per cent said they should not be allowed to travel around the country or choose where they want to live. (excerpt)
Civil-Military Alliance Newsletter. 1996 Aug; 2(3):3-4.This article presents excerpts from a speech by Malawi’s First Vice President and Minister of Defence, the Right Honourable Justin C. Malewezi at the opening address to the policy workshop.
Summary measures of population health in the context of the WHO framework for health system performance assessment.
In: Summary measures of population health: concepts, ethics, measurement and applications, edited by C.J.L. Murray, J.A. Salomon, C.D. Mathers and A.D. Lopez. Geneva, Switzerland, World Health Organization [WHO], 2002. 1-11.This volume addresses the conceptual, ethical, empirical and technical challenges in summarizing the health of populations. This is critical for monitoring whether levels of population health are improving over time and for understanding why health differs across settings. At the same time, it is also important to recognize that improving population health is not the only goal of health policy and to understand the way health improvements interact with these other goals. For that reason, we briefly review the World Health Organization (WHO) framework for assessing the performance of health systems and the role of summary measures of population health (SMPH) in this framework. Following the recent peer review of the methodology used for health system performance by WHO (Anand et al. 2002), this framework will continue to evolve in response to the detailed recommendations of the scientific peer review group and to ongoing scientific debates and research. (excerpt)
Arlington, Virginia, John Snow [JSI], Family Planning Logistics Management [FPLM], 2000. x, 67 p. (USAID Contract No. CCP-C-00-95-00028-00)This report documents the status of technical assistance provided by the USAID-funded Family Planning Logistics Management project to the Bangladesh Family Planning Program in developing a countrywide contraceptive logistics system. A study conducted in November 1999 to evaluate the impact of technical assistance on logistics management and contraceptive security is detailed. The report concludes with findings from the study, lessons learned, and recommendations to continue improvements in the system. (author's)