Pre-exposure Prophylaxis (PrEP) Awareness, Willingness to Use, and Preferred Places for Access Among the Cambodian Female Entertainment Workers: A Cross-Sectional Study.

The aim of the study was to determine the awareness, desire to use, and preferred providers of pre-exposure prophylaxis (PrEP) among Female Entertainment Workers (FEWs) aged 18-35 years in Cambodia's Phnom Penh region. Of 1003 FEWs, 31.8% of them had heard of PrEP. When informed about PrEP, 67.4% said they would use PrEP and the most preferred location to access PrEP was a local non-governmental organization (NGO) (63.2%), followed by a government clinic/center (39.8%), ART clinic (26.5%), pharmacy (20.7%), and CBO (14.8%). FEWs who had heard about PrEP (aOR: 2.46; CI: 1.79-3.39) and those with no additional income source other than sex work (aOR: 1.53; CI: 1.16-2.02) were more likely to express their willingness to use PrEP. When the country is in the process of making provisions for PrEP, the study urges policymakers and programmers to take steps towards creating awareness about PrEP among key populations such as FEWs and its availability preferably through local NGOs and government clinics.

Evaluation of a training program for life skills education and financial literacy to community health workers in India: a quasi-experimental study.

BACKGROUND: Accredited Social Health Activists (ASHA) are community health workers responsible for improving the health status of people by facilitating their access to healthcare services. The life skills of ASHA are known to be effective in negotiating behaviour change in the community; however, there has been a meagre focus towards improving them. Considering this gap, we adopted a comprehensive training program, known as Personal Advancement and Career Enhancement (P.A.C.E.), to empower ASHAs on life skills and financial literacy. The present study intends to assess the training program in two districts of Uttar Pradesh, India, by examining changes in knowledge, perceptions, and practices of ASHAs about life skills and financial literacy. METHODS: We conducted a quasi-experimental, non-randomized, controlled study with pre-and post-test assessments. Data were collected on socio-demographic characteristics, knowledge, and practices related to life skills (communication skills, self-confidence, problem-solving and decision-making skills, time and stress management skills) and financial literacy. Additionally, change perceptions on gender-, life skills-, and savings-related practices at the personal, community, and workplace levels were assessed in the intervention group. Factor analysis was performed to obtain the change patterns by assessing the degree to which the four life skills, financial literacy, and change perceptions on practices were correlated. A general linear regression model was performed to assess associations among change pattern scores and socio-demographic variables. RESULTS: We analyzed the data of 171 ASHAs (intervention group:86 and control group:85). There was a significant improvement in the average post-test scores of all the life skills and financial literacy in the intervention group (p < 0.001). Three distinct change patterns were found post-training in the intervention group. Factor 1 (high loadings for change perceptions on practices) was positively associated with ASHAs aged 38 and above and with experience of ≤12 years. On the contrary, the change in financial literacy and self-confidence scores was common among ASHAs with more than 12 years of experience. CONCLUSIONS: The P.A.C.E training program was found effective in improving the life skills and financial literacy of ASHAs in India.

Evaluation of a community-based intervention for health and economic empowerment of marginalized women in India.

BACKGROUND: Empowered women have improved decision-making capacity and can demand equal access to health services. Community-based interventions based on building women's groups for awareness generation on maternal and child health (MCH) are the best and cost-effective approaches in improving their access to health services. The present study evaluated a community-based intervention aimed at improving marginalized women's awareness and utilization of MCH services, and access to livelihood and savings using the peer-led approach from two districts of India. METHODS: We used peer educators as mediators of knowledge transfer among women and for creating a supportive environment at the household and community levels. The intervention was implemented in two marginalized districts of Uttar Pradesh, namely Banda and Kaushambi. Two development blocks in each of the two districts were selected randomly, and 24 villages in each of the four blocks were selected based on the high percentage of a marginalized population. The evaluation of the intervention involved a non-experimental, 'post-test analysis of the project group' research design, in a mixed-method approach. Data were collected at two points in time, including qualitative interviews at the end line and tracking data of the intervention population (n = 37,324) through an online management information system. RESULTS: Most of the women in Banda (90%) and Kaushambi (85%) attended at least 60% of the education sessions. Around 39% of women in Banda and 35% of women in Kaushambi registered for the livelihood scheme, and 94 and 80% of them had worked under the scheme in these two places, respectively. Women's awareness about MCH seemed to have increased post-intervention. The money earned after getting work under the livelihood scheme or from daily savings was deposited in the bank account by the women. These savings helped the women investing money at times of need, such as starting their work, in emergencies for the medical treatment of their family members, education of their children, etc. CONCLUSION: Peer-led model of intervention can be explored to improve the combined health and economic outcomes of marginalized women.

Assessing universal maternal health service coverage and their determinants in India: A multicentric cross-sectional study.

Introduction: Universal maternal health coverage (UHC) envisages access to quality healthcare services by pregnant and lactating women without any financial hardship. Our present study attempts to assess the UHC for maternal health services and their determinants, including access to quality antenatal care (ANC), quality postnatal care (PNC), and child immunization among the marginalized populations of India. Methods: It was a community-based cross-sectional study across five states of India among pregnant or lactating women. Quality ANC score was calculated using four indicators, including ANC registration month, attendance of four or more ANC visits, receiving at least one tetanus toxoid injection, and consumption of 100 iron-folic acid (IFA) tablets. Similarly, quality PNC care score was calculated using four indicators, including PNC within 48 h, breastfeeding initiation time, institutional delivery, and accessing conditional maternity benefit scheme. Logistic or generalized linear regression was used to depict associations depending on the outcome variables. Results: A total of 12,976 pregnant women's and 18,061 lactating mothers' data were analyzed. Illiterate women, women from below the poverty line, and rural areas had low-quality ANC and PNC scores compared with their counterparts. Marginalized women had lower odds of immunization of children and lower quality PNC scores than nonmarginalized. Conclusions: Sociodemographic factors, such as caste, education of women, area of residence, and economic status, are major determinants of quality ANC and PNC scores and immunization of children. Hence, interventionists ought to design community-based interventions that address the challenges in the uptake of health services.

Association between gender disadvantage factors and postnatal psychological distress among young women: A community-based study in rural India.

Common mental health disorders are studied extensively among adult women globally. However, they remain under-researched among young women. This study aims to determine whether gender disadvantage factors are associated with psychological distress among young women in rural India, where the child sex ratio is lower than the national average. A cross-sectional survey was conducted in rural Pune, India. A total of 229 young married women who had a live birth in the last 12 months were screened for psychological distress. The predictors of psychological distress were estimated using multivariable logistic regression analyses. Psychological distress was found among 50 respondents (21.9%). Young women who were married before 18 years had 2.19 times higher odds of distress than women who were married after 18 years. Young women who gave birth to a female infant had 2.43 times higher odds of distress than those who gave birth to a male infant. Lack of partner support and experience of postnatal health complications were other predictors. Study findings ascertain the role of gender disadvantage factors in causing psychological distress. From a public health perspective, early identification and treatment of psychological distress, is imperative, along with addressing gender inequitable practices.

A qualitative evaluation of an integrated health and livelihood development project for marginalized communities in India.

BACKGROUND: A community-based intervention was implemented to improve maternal, child, and adolescent health practices, promote financial literacy and enhance livelihood opportunities for young people in marginalized communities. A hypothesis related to our intervention was that peer-led education sessions on health and nutrition in conjunction with community mobilization would change communities' perceptions towards maternal and child health. DESIGN AND METHODS: This three-year intervention was done in the two districts of Rajasthan, India, namely Nagaur and Pali. The paper explored the changes in perceptions and practices that resulted from this intervention among women and adolescents. We performed a retrospective, qualitative effect evaluation of the project. Focus group discussions with married women (15-49 years) and adolescents (10-19 years), and in-depth interviews with frontline workers and village health committees were done. The qualitative data were translated, coded, and analyzed thematically using an inductive approach. RESULTS: Overall, 4853 women and 8158 adolescents were engaged in the intervention. The study seemed to have brought a change in some of the practices like postnatal care uptake, breastfeeding, and uptake of antenatal care among women, and enhanced awareness about sexual and reproductive health and harms of substance abuse among adolescents was noted. Around 23% and 67% of the young people from Nagaur and Pali, respectively, were linked with jobs in computer training centres, tailoring centres, and beauty parlours. CONCLUSIONS: The intervention was perceived successful in improving many health and nutrition practices and livelihood opportunities among project beneficiaries, calling for a comprehensive and multi-dimensional intervention to target social determinants of health.

Comparing Reproductive Health Awareness, Nutrition, and Hygiene among Early and Late Adolescents from Marginalized Populations of India: A Community-Based Cross-Sectional Survey.

Adolescence (10-19 years) is marked by many physiological changes and is vulnerable to health and nutritional problems. Adolescence, particularly, early adolescence is inadequately addressed in our national surveys. The present study aimed to assess the reproductive health awareness, nutrition, and hygiene of marginalized adolescent girls and boys and compare them among early and late adolescents. Our cross-sectional study was a part of a community-based project across India's five zones, namely North, East, West, Central, and South. Unadjusted and adjusted logistic regression was performed to compare awareness about HIV/AIDS, or Sexually Transmitted Infections (STI), consumption of Iron Folic Acid (IFA) tablets and three meals in a day, safe menstrual hygiene practices, history of anemia, and open defecation practice among early and late adolescents. Data were reported as unadjusted and adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Among early adolescents, around 58% of girls and boys did not consume IFA tablets, and 28% of girls and 24% of boys defecated in the open. Compared to late adolescents, early adolescent girls had lower odds of awareness about HIV/AIDS (aOR (95% CI): 0.50 (0.47-0.54)) and open defecation (aOR (95% CI): 0.90 (0.83-0.98)) and higher odds of hand hygiene after defecation (aOR (95% CI): 1.52 (1.37-1.68)) and safe menstrual practices (aOR (95% CI): 1.42 (1.23-1.64)). There is a dire need to start public health interventions from early adolescence for long-term benefits throughout adolescence.

Dietary Intakes, Patterns, and Determinants of Children Under 5 Years from Marginalized Communities in Odisha: A Cross-sectional Study.

Pre-school age (3-5 years) children are vulnerable to malnutrition due to poor dietary intake, dietary habits, and socio-economic conditions. Children from marginalized families are more vulnerable than non-marginalized families due to limited access to health- and nutrition-related services, besides other socio-economic factors. This study was done to assess the dietary intakes, patterns, and determinants of pre-school age (3-5 years) children from marginalized populations in two districts of Odisha. We used three different questionnaires, namely general demographic information, single 24-h recall dietary survey, and food frequency questionnaire, to collect data. Dietary patterns were obtained using principal component analysis, and the recommended dietary allowance (RDA) method was applied to estimate the prevalence of inadequate intake. A general linear model of regression was used to investigate the relationship of dietary patterns scores with independent variables. A total of 86 boys (57.3%) and 64 girls (42.7%) were recruited for the study. The majority (more than two-third) of the children had <70% of RDA of iron, vitamin C, and zinc. The three dietary components that best described the dietary patterns among children in the study were vegetarian, non-vegetarian, and mixed patterns. They explained 54.9% of the variability. The 'vegetarian' dietary pattern was inversely associated with children whose mothers were illiterate (p = 0.005), who lived in families having per capita family monthly income less than INR 786 (10.3 US$) (p = 0.007), and who were first born (p = 0.04). The dietary patterns may help interventionists in designing programs aimed at preventing malnutrition and chronic diseases among children in marginalized communities.

Dietary Intake across Reproductive Life Stages of Women in India: A Cross-Sectional Survey from 4 Districts of India.

Nutritional deficiencies among women of reproductive age, especially from socially backward classes, are widely prevalent in India. The present study aimed to assess the nutrient intakes and analyse their associations with sociodemographic attributes among socially backward adolescent girls, newly married women, pregnant women, and lactating mothers from four districts of India. Further, the study looked at the associations between nutrient intakes and anthropometric measurements (body mass index, BMI; waist circumference; and waist-hip ratio, WHR) among adolescents and newly married women. This community-based cross-sectional study used the 24-hour recall method of the dietary survey to assess the food intake of women and girls. Nonparametric tests of associations between sociodemographic characteristics and the median nutrient intakes were conducted. Expected and observed increments in energy and nutrient intakes of pregnant and lactating women from the base (requirement of an adult woman) were calculated. A total of 477 pregnant women, 455 lactating mothers, 532 newly married women, and 223 adolescent girls were interviewed. According to the 24-h dietary recall, only 35% of adolescent girls, 57% newly married women, 40% pregnant women, and 34% lactating mothers were able to meet 70% of the recommended energy requirements. A large percentage of pregnant women had less than 50% of the recommended intakes of iron, calcium, and folic acid. Women living in nuclear families, urban slums, and those from backward classes had lower intakes of almost all the nutrients compared to their counterparts (p < 0.001). There were no significant differences in the nutrient intakes of adolescents, newly married, pregnant, and lactating women, and all had poor dietary intakes. We found positive relationships of all three anthropometric measurements (BMI, waist circumference, and WHR) with fats and inverse associations with carbohydrates. Public health interventions should work towards improving the nutrition of these vulnerable populations.

Dietary Patterns and Determinants of Pregnant and Lactating Women From Marginalized Communities in India: A Community-Based Cross-Sectional Study.

Objective: Dietary pattern analysis has emerged as a balanced and realistic approach that reflects how the food is consumed in real life. However, previous studies have overlooked the two important phases in women's life, pregnancy, and lactation. We aimed to explore dietary patterns and their determinants among pregnant and lactating women from marginalized families in rural areas and urban slums of India. Methods: It was a community-based cross-sectional study conducted across four districts of India, one from each region (North, West, East, and South). We used a structured questionnaire to collect data on socio-demographic characteristics and access to nutrition services. The dietary data were collected using a qualitative food frequency questionnaire having 204 food items, which were clubbed into 16 major food groups. The principal component analysis method was employed to identify dietary patterns (prefixed at 4). We used multinomial logistic regression to explore associations of socio-demographic and access to nutrition services' variables with identified dietary patterns. Results: The data of 476 pregnant and 446 lactating women were assessed. Four patterns explained for 54% of the variation in their food intake. The patterns identified were low-mixed vegetarian (19%), non-vegetarian (15%), high-mixed vegetarian (11%), and calorie-rich (9%). The low-mixed diet was rich in rice, roots and tubers, green leafy vegetables, and other vegetables. The non-vegetarian diet was characterized by high loadings for nuts or seeds, chicken, meat or fish, eggs, beverages (milk-based), and snacks. The high-mixed vegetarian diet was rich in cereals other than rice and wheat, pulses, and fruits. The calorie-rich diet had high factor loadings for wheat, butter and oil, sweets, and milk and milk products. Hindus and women who lived in rural areas had higher odds of consuming a low-mixed vegetarian diet and lower odds of a high-mixed vegetarian diet. Working women and those who received nutrition advice during pregnancy or lactation had 2-3 times higher odds of consuming a high-mixed vegetarian diet. Conclusions: A high prevalence of a low-mixed vegetarian diet among women can have adverse pregnancy and birth outcomes. Healthy dietary patterns during pregnancy and lactation are required to meet the increased micro- and macronutrient requirements for improved maternal and child health.

Validation of Health Education Material for Youth: A Step to Ensure Implementation Fidelity in Community-Based Interventions.

Health education materials such as flipbooks enhance learning and deliver key messages in a captivating mode. Validation of such materials is crucial to ensuring implementation fidelity. We conducted a study to achieve two objectives: (a) to develop two flipbooks, one each for adolescents and young married women (YMW); (b) to validate the flipbooks using five parameters, namely, content validity, construct validity, concurrent validity, relevance, and face validity. The study was a part of a community-based peer-led intervention on health, nutrition, and hygiene. The content validity and relevance were assessed by interviewing outreach workers (ORWs, n = 42) using self-administered five-point Likert scale-based tools. A pre- and post-intervention assessment of knowledge among adolescents (n = 100) and YMW (n = 50) across six out of 13 intervention sites was done to evaluate the construct validity. The two flipbooks contained 12 structured sessions with five key messages per session, in addition to illustrations, discussion points, and theme-based stories at the end of each session. The content and relevancy indices were ranked above 80% by ORW. There was a statistically significant increase in the knowledge scores of adolescents (p < 0.001) and YMW (p < 0.001) post intervention. The validation process helps in assessing the relevance and appropriateness of the education content for greater acceptance and responsiveness by the users.

Relationships between nutrition-related knowledge, attitude, and self-efficacy among adolescents: A community-based survey.

INTRODUCTION: Millions of adolescents are facing the burden of malnutrition in India, and the sociocultural context of nutrition poses challenges while addressing this burden. This study aimed to assess: (a) the determinants of knowledge, attitude, and self-efficacy scores and (b) the relationships between nutrition-related knowledge, attitude, and self-efficacy scores among adolescents in India. METHODS: The community-based study was conducted among adolescents across three rural and three urban districts in India. This observational study employed a self-administered structured questionnaire containing information on demography, nutrition-related knowledge, attitude, and dietary self-efficacy. Differences in knowledge, attitude, and self-efficacy scores between sociodemographic variables were assessed using the t-test. Regression analysis was used to determine relationships between knowledge, attitude, and self-efficacy scores. RESULTS: A total of 985 adolescents (44.5%) from rural areas and 1225 (55.5%) from urban slums participated. There were significant differences in knowledge, and self-efficacy scores between rural, urban inhabitants (P < 0.001), and adolescents with different grades of education (P < 0.001 for knowledge and P = 0.01 for self-efficacy). There were significant differences in knowledge and attitude scores among adolescents from non-backward and backward classes (P < 0.001 for knowledge and P = 0.02 for attitude) and those who were vegetarians and non-vegetarians (P = 0.002 for knowledge and P < 0.001 for attitude). The study demonstrated significant relationships between knowledge, attitude, and self-efficacy scores (P < 0.001). CONCLUSION: Nutrition-related knowledge, attitude, and self-efficacy scores are determinants of dietary behavior and are inter-related. Community-based interventions targeting to improve the nutritional status of adolescents should focus on improving self-efficacy besides the other two determinants.