Period Product Resources and Needs in Missouri Schools: Focus Group Discussions with School Nurses.

This study explored period product resources and needs in Missouri schools from the perspective of school nurses. We conducted eight focus groups with school nurses (n = 51) across Missouri using purposive sampling. Focus group data were analyzed in Dedoose via multiple coders and achieved strong inter-rater reliability (Cohen's Kappa = 0.92). Several interconnected themes with associated sub-themes were identified. First, school nurses do not have sufficient resources to help students manage menstruation and minimize menstruation-related absenteeism. Second, schools' heavy reliance on donations can lead to inconsistencies in supply and a mismatch between what is donated and what is most needed. Third, school nurses desire additional educational resources around menstruation management for students and caregivers. Nurse-identified themes can help inform recommendations for improving schools' response to students' menstrual hygiene needs by highlighting priorities for educational content, resources, and product acquisition with a goal of ensuring the suitability and sustainability of MHM in schools.

Girls' attendance at school after a menstrual hygiene intervention in northern Ethiopia.

OBJECTIVE: To evaluate the effect on school attendance of a menstrual hygiene intervention that distributes educational booklets to school children and menstrual hygiene kits to schoolgirls in northern Ethiopia. METHODS: Attendance was tracked for 8839 students in grades 7-12 during the 2015-2016 academic year when the intervention was implemented. Negative binomial regression was used to test whether student sex predicted post-intervention school absences when controlling for grade-level and pre-intervention absences. Similar attendance data were analyzed for 3569 students in grades 7, 9, and 11 for the 2014-2015 academic year as a historical comparison. RESULTS: Over 12 211 educational booklets were distributed to students and 5991 menstrual hygiene kits were distributed to schoolgirls. After the intervention, girls had 24% fewer school absences than boys. Sex was not a predictor of absences during a similar time-period in the prior school year. CONCLUSION: This is one of the first large studies to show a positive relationship between a menstrual hygiene intervention and girls' school attendance. These positive results suggest such interventions should be expanded to other schools in northern Ethiopia. Future research should explore whether similar interventions can also decrease the rate at which girls drop out of school around menarche.

Intimate partner violence as a predictor of antenatal care service utilization in Honduras / La violencia de pareja como factor predictivo de la utilización de los servicios de control prenatal en Honduras / Violência doméstica praticada pelo parceiro íntimo como preditor da utilização de serviços de atenção pré-natal em Honduras

Objective. To describe the relationship between exposure to physical and/or sexual intimate partner violence (IPV) and indicators of antenatal care (ANC) service utilization among Honduran women of reproductive age. Methods. Data from the 2011-2012 Honduras Demographic and Health Survey were analyzed to describe the relationship between self-reported exposure to IPV and two ANC outcomes: (1) sufficient ANC visits (defined by the Honduran Ministry of Health as five or more visits) and (2) early ANC initiation (within the first trimester). Multiple logistic regression was used to estimate effects of physical and sexual IPV on the outcomes, controlling for women’s age, education, literacy, residence, household size, religion, parity, wealth, husband’s age, and husband’s education. Results. Of women who were married, had at least one living child 5 years or younger, and completed the IPV module (N = 6 629), 13.5% of them reported any physical IPV, and 4.1% reported both physical and sexual IPV. There was no significant association between IPV and early ANC; however, a significant relationship between IPV and sufficient ANC was found. Women who experienced any physical IPV (adjusted odds ratios (aOR) = 1.25; 95% confidence interval (CI): 1.00-1.56) or sexual IPV (aOR = 1.53; 95% CI: 1.08-2.16) were, respectively, 25% and 53% more likely to receive insufficient ANC. Conclusions. Honduras has one of highest rates of interpersonal violence of any nation in the world. In Honduras, IPV is a contributor to this broader category of interpersonal violence as well as a risk factor for insufficient ANC. Our findings suggest that universal IPV screening during ANC as well as future initiatives aimed at reducing IPV might improve ANC utilization in the country.

Objetivo. El presente estudio tuvo por objeto describir la relación entre la exposición a la violencia física o sexual infligida por la pareja y los indicadores de utilización de los servicios de control prenatal por las mujeres hondureñas en edad fecunda. Métodos. Se analizaron los datos de la Encuesta de Demografía y Salud del 2011- 2012 de Honduras con el fin de describir la relación entre la exposición autonotificada a la violencia de pareja y dos resultados de la atención prenatal, a saber: 1) un número suficiente de consultas de control prenatal (definido como cinco o más por el Ministerio de Salud hondureño) y 2) el inicio temprano del control prenatal (durante el primer trimestre del embarazo). Se aplicó un modelo de regresión logística multivariante a fin de calcular los efectos de la violencia de pareja tanto física como sexual en los indicadores, tras ajustar con respecto a la edad de la mujer, la escolaridad, el alfabetismo, el lugar de residencia, el tamaño del hogar, la religión, el número de partos, el nivel de riqueza, la edad de la pareja y su escolaridad. Resultados. De las mujeres casadas, que tenían por lo menos un hijo vivo de 5 años o menor y que completaron el módulo de violencia de pareja de la encuesta (n = 6 629), 13,5% refirieron algún tipo de violencia física y 4,1% notificaron violencia física y sexual infligida por la pareja. No se observó una relación estadísticamente significativa entre la violencia de pareja y el control prenatal temprano; sin embargo, se encontró una asociación significativa entre la violencia de pareja y el número suficiente de consultas de control prenatal. La probabilidad de recibir una atención prenatal insuficiente fue mayor en las mujeres que sufrieron algún tipo de violencia de pareja y, en el caso de la violencia física, fue de 25% (razón de posibilidades ajustadas [ORa]) = 1,25; intervalo de confianza de 95% [IC]: 1,00-1,56) y de la violencia sexual fue 53% (ORa = 1,53; IC de 95%: 1,08-2,16). Conclusiones. Honduras tiene una de las tasas más altas de violencia interpersonal de todos los países del mundo. En este país, la violencia de pareja es un factor que contribuye a la categoría más amplia de la violencia interpersonal y representa además un factor de riesgo de tener un control prenatal insuficiente. Los resultados del presente estudio indican que la detección sistemática universal de la violencia de pareja en el marco de la atención prenatal y las iniciativas futuras encaminadas a reducir este tipo de violencia podrían mejorar la utilización del control prenatal en el país.

Objetivo. Descrever a relação entre a exposição à violência doméstica física e/ou sexual praticada pelo parceiro íntimo e os indicadores de utilização de serviços de atenção pré-natal entre mulheres hondurenhas em idade reprodutiva. Métodos. Foram analisados dados da Pesquisa de Demografia e Saúde 2011–2012 de Honduras para descrever a relação entre a exposição à violência doméstica praticada pelo parceiro íntimo e dois desfechos da atenção pré-natal: (1) consultas de atenção pré-natal em número adequado (definido pelo Ministério da Saúde hondurenho como cinco ou mais consultas) e (2) início precoce da atenção pré-natal (no primeiro trimestre). Foi usada regressão logística múltipla para estimar os efeitos da violência doméstica física e sexual nos desfechos após controlar para idade, nível de escolaridade, alfabetismo, local de domicílio, tamanho da família, paridade e renda da mulher e idade e nível de escolaridade do parceiro. Resultados. Dentre as mulheres casadas, com pelo menos um filho vivo com até 5 anos de idade e que responderam o módulo de violência doméstica (N = 6.629), 13,5% informaram violência física e 4,1% informaram violência física e sexual. Não houve associação significativa entre a violência doméstica e o início precoce da atenção prénatal, porém se verificou uma relação significativa entre a violência doméstica e um número adequado de consultas no pré-natal. As mulheres que vivenciaram violência doméstica física (odds ratio ajustado [aOR] 1,25; intervalo de confiança de 95% [IC 95%] 1.00–1.56) ou sexual (aOR 1,53; IC 95% 1,08–2,16) apresentaram uma chance 25% e 53% maior, respectivamente, de ter atenção pré-natal inadequada. Conclusões. Honduras tem uma de taxas mais elevadas de violência interpessoal de todo o mundo. A violência doméstica praticada pelo parceiro íntimo no país é um fator contribuinte à categoria mais ampla de violência interpessoal e constitui um fator de risco para atenção pré-natal inadequada. Os nossos resultados indicam que o rastreamento universal da violência doméstica na atenção pré-natal, aliado a iniciativas futuras para reduzir este tipo de violência, poderia melhorar a utilização de serviços de atenção pré-natal no país.

Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

BACKGROUND: The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care. METHODS: We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items. RESULTS: We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health services received. CONCLUSIONS: Quality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.

Understanding the black box: a systematic review of the measurement of the community mobilization process in evaluations of interventions targeting sexual, reproductive, and maternal health.

Community mobilization (CM) interventions are often used to improve sexual, reproductive, and maternal health (SRMH). This systematic review provides an overview of CM indicators used in evaluation and then focuses on the use of linking constructs-those measures of the process of CM between programmatic outputs and outcomes. We identified 108 English-language articles evaluating 86 CM interventions that target SRMH. Content analysis was used to code CM indicators into five categories: qualitative descriptions of CM; participation, diffusion and community action indicators that measure tangible, programmatic outputs; and linking constructs that capture the process of moving from participation to empowerment. Fifty-five (64.0%) interventions include a CM indicator. Diffusion indicators are most common (56.4%); linking constructs are least common (20.0%). We found 23 linking constructs used in evaluations of 11 interventions, with limited information on psychometric properties available. Three evaluations report positive relationships between linking constructs and condom use, one of which was significant in multivariate analysis. To better understand how CM leads to improved outcomes, we recommend increasing the measurement of linking constructs in evaluations of CM interventions. Research should focus on developing and validating new linking construct indicators and better disseminating existing measurement tools.

Weight-management interventions for pregnant or postpartum women.

BACKGROUND: A review of randomized controlled trials of weight-management interventions for pregnant or postpartum women was conducted to assess whether effective weight-management interventions exist for this population. METHODS: The MEDLINE, EMBASE, PsycINFO, Sociological Abstracts, and CINAHL databases were searched, as well as the reference lists of relevant publications. English-language articles published between January 1985 and August 2007 that used a randomized controlled trial study design and incorporated a weight-related outcome measure were reviewed. All potentially relevant articles were reviewed separately, and final selections were based on consensus reached through discussion. RESULTS: Three studies met the inclusion criteria, one conducted among pregnant women and two among postpartum women. The interventions addressed modifications in diet and exercise and included individual or group-counseling sessions combined with written and telephone correspondence or food and exercise diaries. In two studies, the weight-related outcome was significantly better in the intervention group than in the control group. The third study found a significant interaction between weight category and intervention group. In all studies, the refusal or attrition rates were high. CONCLUSIONS: While these studies indicate that interventions can help pregnant and postpartum women manage their weight, many questions remain unanswered. Several research gaps for weight-management interventions in this important population have been identified.

From innovation to implementation: the long and winding road.

Building on theory and past research, in early 2000 scientists in the Division of Reproductive Health developed a prevention innovation for CDC's Global AIDS Program for use in countries severely affected by the HIV/AIDS epidemic. This innovative program model is called MARCH: Modeling and Reinforcement to Combat HIV/AIDS (Galavotti et al. Am J Public Health 91:1602-1607, 2001). MARCH promotes behavioral changes that reduce the risk of HIV infection and creates normative environments that sustain these changes through two key program components: entertainment-education using mass media, particularly long-running radio serial dramas, and reinforcement activities at the community level. Using the framework developed by Wandersman et al. (Am J Commun Psychol, 41(3-4), 2008), we describe the key elements of the MARCH prevention innovation and outline how we support its adaptation and implementation. We focus on the following questions: How do we get from an innovative model to effective program implementation in the field? How do we support implementation with fidelity when adaptation is required? And, once implemented, can we demonstrate fidelity of the adaptation to the original program model? Because our program model requires local adaptation for every instance of implementation, we suggest a potential enhancement to the Interactive Systems Framework-support for adaptation of the innovation-as part of the Prevention Support System. In this paper we describe how we supported adaptation of the radio serial drama component for unique contexts in several African countries. We focus attention on the tools and trainings we developed to build innovation specific capacity for implementation, including capacities for adaptation. We then present results of a qualitative analysis of scripts from the MARCH radio serial drama in Zimbabwe to assess the adapted program's fidelity to the original design of the innovation. Finally, we discuss lessons learned and explore implications for the field.