Maternal and familial correlates of anthropometric typologies in the nutrition transition of Colombia, 2000-2010.

OBJECTIVE: We aimed to assess the maternal and family determinants of four anthropometric typologies at the household level in Colombia for the years 2000, 2005 and 2010. DESIGN: We classified children 2) to assess stunting and overweight/obesity, respectively; mothers were categorized according to BMI to assess underweight (<18·5 kg/m2) and overweight/obesity (≥25·0 kg/m2). At the household level, we established four final anthropometric typologies: normal, underweight, overweight and dual-burden households. Separate polytomous logistic regression models for each of the surveyed years were developed to examine several maternal and familial determinants of the different anthropometric typologies. SETTING: National and sub-regional (urban and rural) representative samples from Colombia, South America. SUBJECTS: Drawing on data from three waves of Colombia's Demographic and Health Survey/Encuesta Nacional de Salud (DHS/ENDS), we examined individual and household information from mothers (18-49 years) and their children (birth-5 years). RESULTS: Higher parity was associated with an increased likelihood of overweight and dual burden. Higher levels of maternal education were correlated with lower prevalence of overweight, underweight and dual burden of malnutrition in all data collection waves. In 2010, participation in nutrition programmes for children <5 years, being an indigenous household, food purchase decisions by the mother and food security classification were also associated with the four anthropometric typologies. CONCLUSIONS: Results suggest that maternal and family correlates of certain anthropometric typologies at the household level may be used to better frame policies aimed at improving social conditions and nutrition outcomes.

Intimate partner violence as a predictor of antenatal care service utilization in 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.

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

ABSTRACT 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.

RESUMEN 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.

RESUMO 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 pré-natal, 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.

Effectiveness of Program Modification Strategies of the Diabetes Prevention Program: A Systematic Review.

PURPOSE: The purpose of this study is to review the effectiveness of commonly used program modifications classified under cultural adaptation and program translational strategies for the Diabetes Prevention Program (DPP) in terms of risk reduction for type 2 diabetes. METHODS: Authors extracted data about weight, body mass index (BMI), and 5 areas of program modification strategies from 28 interventions and analyzed them in SPSS software. Bivariate analyses examined the odds of achieving a significant reduction in outcomes by each modification of the DPP and by presence of a maintenance component, as well as the mean reduction of weight and BMI by more versus fewer modifications and by the presence of a maintenance component. RESULTS: There were no statistically significant differences in achieving a significant reduction in weight or BMI by any type of modification or by the presence of a maintenance component. Programs with fewer modifications reported significantly greater reduction in mean weight at 12 months postintervention and the furthest time point extracted. Programs with a maintenance component achieved significantly greater reduction in mean weight measured at the furthest time point extracted. CONCLUSIONS: The DPP appears to be programmatically robust to a variety of cultural adaptation and translational strategies. Potentially cost-saving modifications do not seem to reduce effectiveness, which should encourage implementation on a broader scale. Program planners should, however, make efforts to include maintenance components because they appear to significantly reduce risk for acquiring type 2 diabetes.

The importance of community mobilization in interventions to improve sexual, reproductive, and maternal health outcomes: A review of the evidence.

Community participation, engagement, and mobilization are common components of many sexual, reproductive, and maternal health (SRMH) programs, but little consensus exists among researchers on how critical these program components are. Using principles of realist review, we reviewed a spectrum of community mobilization interventions to evaluate their use in improving five SRMH areas. Consistent with theoretical assumptions, we found that actively involving community members in leading intervention activities and/or taking ownership tends to produce better SRMH outcomes than simply relying on community members as implementers. Despite this, many fewer programs exist with this meaningful level of engagement than with more cursory engagement.

Methodological innovations in public health education: transdisciplinary problem solving.

In 2008, the faculty of the Brown School at Washington University in St. Louis designed a Master of Public Health program centered on transdisciplinary problem solving in public health. We have described the rationale for our approach, guiding principles and pedagogy for the program, and specific transdisciplinary competencies students acquire. We have explained how transdisciplinary content has been organized and delivered, how the program is being evaluated, and how we have demonstrated the feasibility of this approach for a Master of Public Health degree.

Environmental characteristics associated with pedestrian-motor vehicle collisions in Denver, Colorado.

OBJECTIVES: We examined patterns of pedestrian-motor vehicle collisions and associated environmental characteristics in Denver, Colorado. METHODS: We integrated publicly available data on motor vehicle collisions, liquor licenses, land use, and sociodemographic characteristics to analyze spatial patterns and other characteristics of collisions involving pedestrians. We developed both linear and spatially weighted regression models of these collisions. RESULTS: Spatial analysis revealed global clustering of pedestrian-motor vehicle collisions with concentrations in downtown, in a contiguous neighborhood, and along major arterial streets. Walking to work, population density, and liquor license outlet density all contributed significantly to both linear and spatial models of collisions involving pedestrians and were each significantly associated with these collisions. CONCLUSIONS: These models, constructed with data from Denver, identified conditions that likely contribute to patterns of pedestrian-motor vehicle collisions. Should these models be verified elsewhere, they will have implications for future research directions, public policy to enhance pedestrian safety, and public health programs aimed at decreasing unintentional injury from pedestrian-motor vehicle collisions and promoting walking as a routine physical activity.

Radio role models for the prevention of mother-to-child transmission of HIV and HIV testing among pregnant women in Botswana.

Although Botswana supports a program for the prevention of mother-to-child-transmission of HIV (PMTCT), many women initially did not take advantage of the program. Using data from a 2003 survey of 504 pregnant and post-partum women, we assessed associations between exposure to a long-running radio serial drama that encourages use of the PMTCT program and HIV testing during pregnancy. Controlling for demographic, pregnancy and other variables, women who spontaneously named a PMTCT character in the serial drama as their favorite character were nearly twice as likely to test for HIV during pregnancy as those who did not. Additionally, multiparity, knowing a pregnant woman taking AZT, having a partner who tested, higher education and PMTCT knowledge were associated with HIV testing during pregnancy. Identification with characters in the radio serial drama is associated with testing during pregnancy. Coupled with other supporting elements, serial dramas could contribute to HIV prevention, treatment and care initiatives.

"One day I might find myself HIV-positive like her": audience involvement and identification with role models in an entertainment-education radio drama in Botswana.

Entertainment-education programs promote health and development goals throughout the world. This study looks specifically at a radio serial drama designed to provide behavioral role models for HIV prevention and reproductive health in Botswana as part of the behavior-change strategy, Modeling and Reinforcement to Combat HIV/AIDS (MARCH). The purpose of this qualitative study is to elucidate regular listeners' involvement and identification with three different types of fictional characters in the drama. Regular listeners were interviewed using a semi-structured guide; 31 interviews were analyzed to assess respondents' reactions to three female characters. The findings suggest that characters designed to be "negative," "positive," and "transitional" (i.e., moving from negative to positive) role models were generally perceived as such and that the type of behavior modeled influenced whether a character was perceived to be transitional or positive. Audience members discussed the implications of specific behaviors by contrasting the different character types. Although characters modeled behaviors within distinct but interrelated storylines, the respondents spontaneously compared characters' ways of confronting similar dilemmas across storylines, suggesting that listeners perceived the drama as a unified whole rather than as a series of parallel stories. The use of more than one transitional character for each behavioral objective might be beneficial for improving audience identification with agents of behavior change by providing several models to which the audience can relate.