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BMC Pregnancy and Childbirth. 2017 Jun 5; 17(1):170.BACKGROUND: Judicious utilization of drugs rescues the fetus from the harmful effects while treating the health problems of the pregnant women. This study aimed at evaluating drug utilization pattern and its associated factors among pregnant women in Southern Tigray, Ethiopia. METHOD: Institution based cross-sectional study was conducted among 647 pregnant women who had been attending obstetrics-gynecology and antenatal care units in different health facilities of Southern Tigray region. The study participants were selected using multistage sampling technique. Data collection was done using pre-tested semi-structured questionnaires and by reviewing antenatal follow-up cards. Descriptive and inferential statistics were analyzed, to assess drug utilization pattern and its associated factors among pregnant women, using SPSS version 20 software. RESULTS: Of 647 pregnant women, 87.5% were prescribed with at least one medication. As per the United States Food and Drug Administration (US-FDA) risk classification system, 87.7, 7.9, 3.9, and 0.5% of the prescribed drug were from category A, B, C and D, respectively. Prescription drug use was more likely among gynecology ward visitors [AOR = 8.97, 95% Cl (2.69-29.88)] and among those who visited health facilities for the first time during their first [AOR =2.65, 95% Cl (1.44-4.84)] and second [AOR = 2.50, 95% Cl (1.36-4.61)] trimesters. CONCLUSION: Majority of the study population used safe and appropriate medications according to US-FDA risk classification system, with the exception of low proportion (0.5%) of medication with potential risk for the fetus. The average number of drug prescribed per pregnant women was in the recommended range of WHO drug use indicators guideline.
Health Policy and Planning. 2015 Feb; 30(1):8-18.Kyrgyzstan has adopted a number of policy initiatives to deal with an accelerating HIV/AIDS epidemic. This article explores the main actors in HIV/AIDS policy-making, their interests, support and involvement and their current ability to set the agenda and influence the policy-making process. Fifty-four semi-structured interviews were conducted in the autumn of 2011, complemented by a review of policy documents and secondary sources on HIV/AIDS in Kyrgyzstan. We found that most stakeholders were supportive of progressive HIV/AIDS policies, but that their influence levels varied considerably. Worryingly, several major state agencies exhibited some resistance or lack of initiative towards HIV/AIDS policies, often prompting international agencies and local NGOs to conceptualize and drive appropriate policies. We conclude that, without clear vision and leadership by the state, the sustainability of the national response will be in question.
Reproductive Health. 2015 Sep 18; 12(90):1-13.Background Young people make up for 24.5 % of Latin America’s population. Inadequate supply of specific and timely sexual and reproductive health (SRH) services and sexuality education for young people increases their risk of sexual and reproductive ill health. Colombia is one of the few countries in Latin America that has implemented and scaled up specific and differentiated health and SRH services-termed as its Youth Friendly Health Services (YFHS) Model. Objective To provide a systematic description of the crucial factors that facilitated and hindered the scale up process of the YFHS Model in Colombia. Methods A comprehensive literature search on SRH services for young people and national efforts to improve their quality of care in Colombia and neighbouring countries was carried out along with interviews with a selection of key stakeholders. The information gathered was analysed using the World Health Organization-ExpandNet framework (WHO-ExpandNet). Results/Discussion In 7 years (2007-2013) of the implementation of the YFHS Model in Colombia more than 800 clinics nationally have been made youth friendly. By 2013, 536 municipalities in 32 departments had YFHS, resulting in coverage of 52 % of municipalities offering YHFS. The analysis using the WHO-ExpandNet framework identified five elements that enabled the scale up process: Clear policies and implementation guidelines on YFHS, clear attributes of the user organization and resource team, establishment and implementation of an inter-sectoral and interagency strategy, identification of and support to stakeholders and advocates of YFHS, and solid monitoring and evaluation. The elements that limited or slowed down the scale up effort were: Insufficient number of health personnel trained in youth health and SRH, a high turnover of health personnel, a decentralized health security system, inadequate supply of financial and human resources, and negative perceptions among community members about providing SRH information and services to young people. Conclusion Colombia’s experience shows that for large-scale implementation of youth health programmes, clear policies and implementation guidelines, support from institutional leaders and authorities who become champions of YFHS, continuous training of health personnel, and inclusion of users in the design and monitoring of these services are key.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2015 Apr.  p. (SR-15-118H; USAID Cooperative Agreement No. AID-OAA-L-14-00004)This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s. The family planning movement in Haiti began in the 1960s, only a short time after family planning activities had been initiated in many other countries in the Latin American and Caribbean region. Initially, doctors and demographers worked together to encourage government policies around the issue and to begin private sector service provision programs in much the same way early family planning activities occurred elsewhere. Yet, in comparison with other countries within the region, Haiti’s progress on reproductive health has been slow.
Journal of Midwifery and Women's Health. 2011 Nov; 56(6):598-607.In the late 1990s, the World Health Organization (WHO) created the Medical Eligibility Criteria for Contraceptive Use (MEC), which provide evidence-based recommendations for safe and effective contraception in women with medical problems. The WHO MEC incorporate the best available evidence, are periodically updated, and are designed to be modified for specific populations. The US Centers for Disease Control and Prevention published US MEC in 2010. Changes to WHO guidelines for use in the US population include the following areas: breastfeeding, intrauterine device use, valvular heart disease, ovarian cancer, uterine fibroids, and venous thromboembolism. Medical conditions not covered by WHO recommendations but added to the US MEC include contraceptive guidance for women with inflammatory bowel disease, history of bariatric surgery, rheumatoid arthritis, endometrial hyperplasia, history of peripartum cardiomyopathy, and history of solid organ transplant. This article reviews the changes and additions to WHO MEC found in the US MEC. (c) 2011 by the American College of Nurse-Midwives.
Gender-based violence in Viet Nam: Strengthening the response by measuring and acting on the social determinants of health. Draft background paper.
[Unpublished] 2011. Draft background paper commissioned by the World Health Organization for the World Conference on Social Determinants of Health, Rio de Janeiro, Brazil, 19-21 October 2011.  p. (WCSDH/BCKGRT/4C/2011; Draft Background Paper 4C)The successful completion of the NSDVVN with subsequent dissemination of results and feedback into policymaking demonstrates several key lessons for addressing health inequities by acting on the social determinants of health. First, data collection is time-consuming and costly, but necessary. Selection of research methodology and indicators must be considered and goal-oriented, as the indicators measured (or not) will significantly impact the potential uses of data. Finally, including men in research provides an entry point for men and boys to become agents of social change with respect to policy implementation. Of note, the NSDVVN provided some measure of gender inequality, but root causes are frequently more challenging to quantify than health disparities themselves. The 2011-2020 NSGE has potential to prevent GBV by acting on its key determinant, gender inequality. Viet Nam can now draw upon this research and its increased capacity to more directly assess gender inequality -- a baseline for evaluating the effects of the NSGE and its Plans of Action on gender equality and GBV. (Excerpt)
Measuring and responding to gender-based violence in the Pacific: Action on gender inequality as a social determinant of health. Republic of Kiribati. Draft background paper.
[Unpublished] 2011. Draft background paper commissioned by the World Health Organization for the World Conference on Social Determinants of Health, Rio de Janeiro, Brazil, 19-21 October 2011.  p. (WCSDH/BCKGRT/4B/2011; Draft Background Paper 4B)The successful implementation of the FHSS with the subsequent development of responsive policies to tackle the problem of GBV in Kiribati demonstrate several key lessons for other problems to be addressed, perhaps in other contexts. First, data collection is a time-consuming and expensive process, but it is necessary to assess and understand health issues in order to develop responsive policies. Communities and municipalities / provinces should be informed of the study (with a safe name, if deemed necessary) prior to its initiation, so as to facilitate collaboration. If staff capacity and/or expertise is lacking, appropriate sources of support should be identified and utilized, not only to ensure a successful research project, but in order to build national capacity. It was important in Kiribati that government officials carried out the study and follow-up activities -- and that they were publicly perceived to do so. Consistent (and appropriate) stakeholder engagement throughout the intervention was critical for credibility, successful implementation and acceptance of results. The selection of the research methodology must also be considered and goal-oriented: the indicators included in an investigation (or not) will determine, in large part, the information collected and its potential uses. The WHO multi-country study offers a validated methodology for measuring GBV, which has proved to be replicable in the Pacific. The Kiribati FHSS was able to inspire policy responses to both GBV and its key determinant, gender inequality, because it included gender-sensitive indicators and metrics of gender inequality itself (qualitative in this instance). Additionally, the qualitative research sufficiently focused on men, validating while attempting to understand their perspectives so that men and boys may be involved as agents of social change. Given the apparent recognition in Kiribati that gender inequality fuels its epidemic of GBV, monitoring and evaluation of its policies on EVAW and gender equality should include an assessment of gender inequality. The FHSS included some metrics of gender inequality, but as mentioned above, the NAP on EVAW will need to be supplemented by additional monitoring to adequately measure changes in gender inequality. As challenging as it was to accumulate sufficient political will and attention to GBV for completion of the FHSS, a more thorough assessment of gender equality should be conducted so as to provide a baseline against which the effects of the National Policies on Gender Equality and EVAW can be measured. While the determinants of GBV itself -- largely gender equality, are more challenging to quantify than its incidence or prevalence, WHO’s Regional Office for the Western Pacific has identified some indicators of gender equity and repeat focus groups could provide quantitative data. (Excerpt)
Gender-based violence in Solomon Islands: Translating research into action on the social determinants of health. Draft background paper.
[Unpublished] 2011. Draft background paper commissioned by the World Health Organization for the World Conference on Social Determinants of Health, Rio de Janeiro, Brazil, 19-21 October 2011.  p. (WCSDH/BCKGRT/4A/2011; Draft Background Paper 4A)The successful implementation of the SIFHSS with resultant policy development provides several key lessons for addressing other health inequities, perhaps in other contexts. First, data collection is a time-consuming and expensive process, but is necessary to effectively understand health issues for responsive policymaking. The selection of research methodology and indicators must be well-considered, comprehensive and goal-oriented: the indicators measured (or not) will significantly determine, the information collected and its potential uses. The WHO multi-country study provides a validated methodology for measuring GBV, replicable in all regions, including the Pacific.The SIFHSS was able to catalyze policy responses to both GBV and its key determinant -- gender inequality -- because, building on WHO methodology, it included gender-sensitive indicators and metrics of gender inequality itself (qualitative in this instance). Furthermore, the qualitative research sufficiently focused on men, at once validating and attempting to understand their perspectives so that men and boys may be meaningfully involved as agents of social change. Second, research implementation should be completed in a context-specific and respectful manner that allows for study rigor as well as the safety and well being of its research team. Recruitment, selection and training are important for the successful completion of the study, and applicants should be given detailed information of the work required and living situation during fieldwork, including time away from home. Positive attitudes and teamwork skills are invaluable. Communities should be informed of the study (with a safe name, if necessary) in advance so as to facilitate collaboration and reduce study team harassment. Travel logistics, accommodation and board in research sites should be anticipated and pre-organized. If staff capacity and/or expertise is lacking, external sources of support should be identified and utilized to ensure a successful project while building national capacity. (Excerpt)
Journal of Women's Health. 2011 Jun; 20(6):825-8.Abstract Women with unintended pregnancies are more likely to experience poor pregnancy outcomes. For women with medical conditions, unintended pregnancy may worsen the condition and carry even greater risk of adverse pregnancy outcomes, including maternal and perinatal death. Although safe and highly effective contraceptive methods are available to prevent unintended pregnancy, there may be concerns about the safety of contraceptive methods among women with medical conditions. The Centers for Disease Control and Prevention (CDC) has recently developed the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, which provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions. Most women, even those with medical conditions, can safely use most methods of contraception.
Geneva, Switzerland, WHO, 2011.  p.This tool, developed in collaboration between WHO, the Office of the High Commissioner for Human Rights (OHCHR) and the Swedish International Development Cooperation Agency (Sida) is designed to support countries to strengthen national health strategies by applying human rights and gender equality commitments and obligations. The tool poses critical questions to identify gaps and opportunities in the review or reform of health sector strategies.
Finnish Official Development Aid for sexual and reproductive health and rights in sub-Saharan Africa.
Finnish Yearbook of Population Research. 2010; 45:143-170.Finland is one of the donor countries that is most supportive in family planning (FP), Sexual and Reproductive Health and Rights (SRHR) and gender issues. This study examines Finnish ODA for FP and SRHR: its decision-making structure, other stakeholders and funding levels. Data consists of documents from the Ministry for Foreign Affairs (MFA) and interviews conducted at the MFA and with other experts. While Parliament decides on the overall level of ODA funding, the Minister for Foreign Trade and Development has considerable autonomy. Other stakeholders such as the All-Party Parliamentary Group on Population and Development and the Family Federation of Finland (Väestoliitto) engage in advocacy work and have influenced development policy. Although the Development Policy 2007 mentions the importance of health and SRHR issues and HIV/AIDS is a cross-cutting issue, interviewees stated that the importance of health and SRHR in ODA has declined and that the implementation of cross-cutting issues is challenging. Multilateral funding for UNFPA, UNAIDS and GFATM, and thus the proportion of SRHR funding within the health sector, is however currently rising. Funding for population-related activities has increased and represented 4.8% of Finland's total ODA in 2009. Almost all of this funding is directed towards basic reproductive health and HIV/AIDS issues and the majority is directed through multilateral channels (78% in 2009), mainly UNFPA and UNAIDS. IPPF, Ipas and Marie Stopes International also receive support.
The USAID | DELIVER project improves patient access to essential medicines in Zambia. Success story.
Arlington, Virginia, JSI, DELIVER, 2011 Feb.  p.Success story on a logistics system pilot project in Zambia that set out to cost-effectively improve the availability of lifesaving drugs and other essential products at health facilities.
Pandemic influenza A H1N1: Vaccination campaigns protect the most vulnerable populations in Togo. Photo and caption.
Arlington, Virginia, JSI, DELIVER, 2010 Dec.  p.During two countrywide vaccination campaigns, Togo's MOH immunized 10 percent of its most at-risk populations. Togo is one of 40 countries conducting a national H1N1 immunization campaign in collaboration with WHO and the USAID | DELIVER PROJECT.
U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition.
MMWR. Recommendations and Reports. 2010 Jun 18; 59(RR-4):1-86.CDC created U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, from guidance developed by the World Health Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in Atlanta, Georgia, during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the WHO guidance and covers >60 characteristics or medical conditions. However, some WHO recommendations were modified for use in the United States, including recommendations about contraceptive use for women with venous thromboembolism, valvular heart disease, ovarian cancer, and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added to the U.S. guidance for women with rheumatoid arthritis, history of bariatric surgery, peripartum cardiomyopathy, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation. The recommendations in this document are intended to assist health-care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.
Adaptation of the World Health Organization's Medical Eligibility Criteria for Contraceptive Use for use in the United States.
Contraception. 2010 Jul; 82(1):3-9.BACKGROUND: The Centers for Disease Control and Prevention (CDC) recently adapted global guidance on contraceptive use from the World Health Organization (WHO) to create the United States Medical Eligibility Criteria for Contraceptive Use (MEC). This guidance includes recommendations for use of specific contraceptive methods by people with certain characteristics or medical conditions. STUDY DESIGN: CDC determined the need and scope for the adaptation, conducted 12 systematic reviews of the scientific evidence and convened a meeting of health professionals to discuss recommendations based on the evidence. RESULTS: The vast majority of the US guidance is the same as the WHO guidance and addresses over 160 characteristics or medical conditions. Modifications were made to WHO recommendations for six medical conditions, and recommendations were developed for six new medical conditions. CONCLUSION: The US MEC is intended to serve as a source of clinical guidance for providers as they counsel clients about contraceptive method choices. Published by Elsevier Inc.
Contraception. 2010 Jul; 82(1):113-8.This article aims to stimulate research to address gaps in the Medical Eligibility Criteria for Contraceptive Use so that more women have access to the most appropriate contraceptive methods, based on safety and effectiveness, for their particular condition and characteristics. It identifies the three conditions for which further research is needed; contraception for obese women, contraception for breastfeeding women, and contraception for women with HIV or AIDS. Copyright © 2010 Elsevier Inc. All rights reserved.
Washington, D.C., Advocates for Youth, .  p. (From Research to Practice)This article defines and describes emergency contraception, its effectiveness, available forms, conditions of its availability in the United States, regimen specifics, efficacy, modes of action, safety and screening issues, side effects, and barriers and ways to dismantle them, especially for young women. Statements on emergency contraception from prominent health organizations are also provided.
Bulletin of the World Health Organization. 2010 Jan; 88(1):3.The rationale for strengthening linkages between sexual and reproductive health and HIV programs is well recognized, and benefits that have accrued from these linkages have been discussed in the November 2009 issue of the Bulletin of the World Health Organization and elsewhere. However, real progress in scaling up such approaches has been modest and slow to materialize.
Agenda for accelerated country action for women, girls, gender equality and HIV: Operational plan for the UNAIDS action framework: Addressing women, girls, gender equality and HIV.
Geneva, Switzerland, UNAIDS, . vi, 28 p.The UNAIDS Action Framework was developed to address the gender inequalities and human rights violations that put women and girls at a greater risk of HIV and that threaten the gains that have been made in preventing HIV transmission and in increasing access to antiretroviral therapy. It focuses on country-level action, capitalizes on the role of the UN joint teams on AIDS, and fosters country leadership.
Arlington, Virginia, John Snow [JSI], DELIVER, 2008 Aug. 81 p. (USAID Contract No. GPO-I-01-06-00007-00)In August 2008, Todd Dickens (PATH), with assistance from the USAID | DELIVER PROJECT, Task Order 1, conducted a review of the IDA-funded procurement of health care commodities under the Health, Nutrition, and Population Sector Program in Bangladesh. The study’s overall objective was to identify bottlenecks and problems that have lead to recent stockouts of contraceptives, and recommend possible actions that the Government of Bangladesh, USAID and development partners can take to address these problems that will improve the overall efficiency and effectiveness of the procurement process and support contraceptive security in Bangladesh.
Washington, D.C., Constella Futures, Health Policy Initiative, 2008 Nov.  p. (USAID Contract No. GPO-I-01-05-00040-00)This report describes how the Government of Peru was successful in diversifying its procurement options and mechanisms for contraceptive commodities. It shows the progress made between 1999, when Peru began purchasing contraceptive supplies with public funds, and mid-2007, when important changes were made in procurement channels. Today, the Peruvian government procures contraceptives from multiple national and international suppliers and is able to negotiate for favorable prices and other terms. (Author's abstract)
Indian Journal of Medical Research. 2008 Jul; 128(1):87-8.This correspondence discusses HIV/AIDS in India and the problem with some of the NGOs in the country. It explains that the World Bank and India’s National AIDS Control Organisation (NACO) lashed out and dismissed nearly 350 NGOs in India for their corruptive spending of money intended for HIV/AIDS prevention.
New York, United Nations, Department of Economic and Social Affairs, 2008. 101 p.This publication shows how various parts of the United Nations system support youth development with a diverse range of programs covering all 15 priority areas of the World Programme of Action for Youth. Several of these priority areas relate to reproductive health and HIV, and numerous UN agencies include activities on these topics in their programming. This document includes illustrative activities for each agency, key publications, and contact information.
AIDS. 2008; 22 Suppl 2:S9-S17.The University of California, Los Angeles Program in Global Health performed a landscape analysis based on interviews conducted between November 2006 and February 2007 with 35 key informants from major international organizations conducting HIV/AIDS work. Institutions represented included multilateral organizations, foundations, and governmental and non-governmental organizations. The purpose of this analysis is to assist major foundations and other institutions to understand better the international HIV/AIDS policy landscape and to formulate research and development programmes that can make a significant contribution to moving important issues forward in the HIV/AIDS policy arena. Topics identified during the interviews were organized around the four major themes of the Ford Foundation's Global HIV/AIDS Initiative: leadership and leadership development; equity; accountability; and global partnerships. Key informants focused on the need for a visionary response to the HIV pandemic, the need to maintain momentum, ways to improve the scope of leadership development programmes, ideas for improving gender equity and addressing regional disparities and the needs of vulnerable populations, recommendations for strengthening accountability mechanisms among governments, foundations, and civil society and on calling for increased collaboration and partnership among key players in the global HIV/AIDS response. (Author's)
Arlington, Virginia, JSI, DELIVER, 2004 Nov.  p. (On Track)El Salvador has already reached several important milestones in its efforts to achieve contraceptive security-the guarantee that all people who wish to use contraceptives can choose, obtain, and use them at all times. With support from the United States Agency for International Development (USAID), the Salvadoran Ministry of Health (MOH) has recently worked to expand people's access to contraceptives, particularly through community-based distribution. It has also helped to improve product management in health facilities by training service providers and by implementing a contraceptive logistics management information system. El Salvador's next challenge on the pathway to contraceptive security is to become financially self-sufficient in procuring reproductive health commodities. USAID is progressively phasing out its contraceptive donations to the country, and is providing technical assistance to guarantee that the MOH will be able to accurately forecast contraceptive demand and manage its own budget for meeting that demand. (author's)