Determination of Oxidized Lipids in Commonly Consumed Foods and a Preliminary Analysis of Their Binding Affinity to PPARγ.

Foods rich in poly unsaturated fatty acids (PUFA) are vulnerable to oxidation. While it is well established that endogenously derived oxidized lipids are ligands of the transcription factor PPARγ, the binding ability of diet-derived oxidized lipids is unknown. Our two-fold objective was to determine the oxidized lipid content and PPARγ binding ability of commonly consumed foods. Extracted food lipids were assayed for the peroxide value, conjugated dienes, and aldehydes, and PPARγ binding was assessed by an in vitro PPARγ ligand screening assay. Oxidized lipids were present in all foods tested at the time of purchase, and oxidation did not increase during storage. The peroxide values for walnuts, sunflower seeds, and flax meal were significantly lower at the end of three months as compared to the day of purchase (peroxide value: 1.26 ± 0.13 vs. 2.32 ± 0.4; 1.65 ± 0.23 vs. 2.08 ± 0.09; 3.07 ± 0.22 vs. 9.94 ± 0.75 mEq/kg fat, p ≤ 0.05, respectively). Lipids extracted from French fries had the highest binding affinity (50.87 ± 11.76%) to PPARγ compared to other foods. Our work demonstrates that oxidized lipids are present in commonly consumed foods when purchased, and for the first time demonstrates that some contain ligands of PPARγ.

Elevating Social and Behavior Change as an Essential Component of Family Planning Programs.

The global family planning community has made significant progress towards enabling 120 million more women and girls to use contraceptives by 2020, though we enter the decade ahead with a long road yet to travel. While investment in strong health systems and supply chains is still needed, the supply-driven approach dominant in family planning fails to address the individual, relational, and social barriers faced by women and couples in achieving their reproductive intentions and desired family size. Overcoming these barriers will require a better understanding of behavioral drivers and the social environment in which family planning decisions are made, and an increased investment in the proven, yet underutilized, approach of social and behavior change (SBC). We make the case that a more intentional focus on the science of human behavior in family planning can help advance the achievement of global, regional, and national goals while also calling for strategic and sustained investment that reflects the critical importance and proven impact of SBC approaches.

Inadequate birth spacing is perceived as riskier than all family planning methods, except sterilization and abortion, in a qualitative study among urban Nigerians.

BACKGROUND: Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians. METHODS: A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach. RESULTS: The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items. CONCLUSION: Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants' risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items' perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing. TRIAL REGISTRATION NUMBER: This study is not a randomized control trial so the study has not been registered as such.

"Doctors are in the best position to know ": The perceived medicalization of contraceptive method choice in Ibadan and Kaduna, Nigeria.

OBJECTIVES: The medicalization and clinic-based distribution of contraceptive methods have been criticized as barriers to increasing levels of contraceptive use in Nigeria and other settings; however, our understanding of how clients themselves perceive the contraceptive method decision-making process is very limited. METHODS: Focus group discussions among men and women in Ibadan and Kaduna, Nigeria, were used to examine attitudes and norms surrounding contraceptive method decision-making in September and October of 2010. RESULTS: Choosing a family planning method was presented as a medical decision: best done by a doctor who conducts clinical tests on the client to determine the best, side effect free, contraceptive method for each client. An absolute trust in health professionals, hospitals, and governments to provide safe contraception was evident. CONCLUSION: The level of medicalization placed on contraceptive method choice by urban Nigerians is problematic, especially since a test that can determine what contraceptive methods will cause side effects in an individual does not exist, and side effects often do occur with contraceptive method use. PRACTICE IMPLICATIONS: Provider and client education approaches would help to improve client involvement in contraceptive decision-making and method choice.

The Integrated Gateway Model: a catalytic approach to behavior change.

OBJECTIVES: To develop and test an Integrated Gateway Model of behaviors and factors leading to subsequent positive reproductive, maternal, and child health behaviors. METHODS: A secondary analysis was conducted using previously published household survey data collected from men (n=5551; 2011) and women (n=16144; 2011) in Nigeria and women in Egypt (n=2240; 2004-2007). The number of health behaviors each potential gateway behavior predicted was assessed by multivariate regression, adjusting for potential confounders. The influence of gateway factors on gateway behaviors was tested via interaction terms. Gateway behaviors and factors were ranked by the number of health outcomes predicted, both separately and synergistically. RESULTS: The key gateway behavior identified in both datasets was spousal communication about family planning, whereas the key gateway factor was exposure to family planning messages. CONCLUSIONS: The model could facilitate innovative research and programming that in turn might promote cascades of positive behaviors in reproductive, maternal, and child health.

Perceived Risks Associated with Contraceptive Method Use among Men and Women in Ibadan and Kaduna, Nigeria.

Research shows that side effects are often the most common reason for contraceptive non-use in Nigeria; however, research to date has not explored the underlying factors that influence risk and benefit perceptions associated with specific contraceptive methods in Nigeria. A qualitative study design using focus group discussions was used to explore social attitudes and beliefs about family planning methods in Ibadan and Kaduna, Nigeria. A total of 26 focus group discussions were held in 2010 with men and women of reproductive age, disaggregated by city, sex, age, marital status, neighborhood socioeconomic status, and--for women only--family planning experience. A discussion guide was used that included specific questions about the perceived risks and benefits associated with the use of six different family planning methods. A thematic content analytic approach guided the analysis. Participants identified a spectrum of risks encompassing perceived threats to health (both real and fictitious) and social concerns, as well as benefits associated with each method. By exploring Nigerian perspectives on the risks and benefits associated with specific family planning methods, programs aiming to increase contraceptive use in Nigeria can be better equipped to highlight recognized benefits, address specific concerns, and work to dispel misperceptions associated with each family planning method.

Family planning providers' perspectives on family planning service delivery in Ibadan and Kaduna, Nigeria: a qualitative study.

OBJECTIVE: In Nigeria, fertility continues to be high and contraceptive prevalence remains low. This study was conducted in order to understand the perceptions of, experiences with and challenges of delivering family planning services in two urban areas of Nigeria from the perspectives of family planning service providers. METHODS: A qualitative study using 59 in-depth interviews was conducted among family planning providers working in hospitals, primary health centres, clinics, pharmacies and patent medicine vendors in Ibadan and Kaduna, Nigeria. RESULTS: Providers support a mix of individuals and organisations involved in family planning provision, including the government of Nigeria. The Nigerian government's role can take a variety of forms, including providing promotional materials for family planning facilities as well as facilitating training and educational opportunities for providers, since many providers lack basic training in family planning provision. Providers often describe their motivation to provide in terms of the health benefits offered by family planning methods. Few providers engage in any marketing of their services and many providers exclude youth and unmarried individuals from their services. CONCLUSIONS: The family planning provider community supports a diverse network of providers, but needs further training and support in order to improve the quality of care and market their services. Adolescents, unmarried individuals and women seeking post-abortion care are vulnerable populations that providers need to be better educated about and trained in how to serve. The perspectives of providers should be considered when designing family planning interventions in urban areas of Nigeria.

Transitions to adulthood: examining the influence of initiation rites on the HIV risk of adolescent girls in Mangochi and Thyolo districts of Malawi.

Although some cultural practices have been identified as a determinant of HIV transmission, research investigating how specific practices affect HIV risk is lacking. In Malawi, initiation rites, in which young people attend ceremonies around the time of puberty, have received little attention. In this qualitative study, we explored whether communities in southern Malawi perceive initiation rites to be an HIV risk factor for girls. Twelve focus group discussions were held with adolescents and adults in a rural community of Thyolo district and a peri-urban community of Mangochi district. Community members observed that certain aspects of traditional initiation rites propel girls into sexual roles expected of adulthood, without facilitating their adaption to the emerging landscape of HIV, thereby increasing HIV risk. HIV prevention programming needs to address the role of initiation rites in adolescent girls' vulnerability to HIV and help young girls navigate the conflicting messages they receive from a wide range of channels about expected sexual behavior.

Structural determinants of adolescent girls' vulnerability to HIV: views from community members in Botswana, Malawi, and Mozambique.

In sub-Saharan Africa, adolescent girls are three to four times more likely than adolescent boys to be living with HIV/AIDS. A literature review revealed only four studies that had examined HIV vulnerability from the perspective of community members. None of the studies focused specifically on adolescent girls. To fill this gap, in 2008 12 focus group discussions were held in selected peri-urban and rural sites in Botswana, 12 in Malawi, and 11 in Mozambique to identify factors that render girls vulnerable to HIV infection from the community members' perspective. The preponderance of comments identified structural factors--insufficient economic, educational, socio-cultural, and legal support for adolescent girls--as the root causes of girls' vulnerability to HIV through exposure to unprotected sexual relationships, primarily relationships that are transactional and age-disparate. Community members explicitly called for policies and interventions to strengthen cultural, economic, educational, and legal structures to protect girls, recognized community members' responsibility to take action, and requested programs to enhance adult-child communication, thus revealing an understanding that girls' vulnerability is multi-level and multi-faceted, so must be addressed through a comprehensive approach to HIV prevention.