Zika virus knowledge, contraception use, and lessons learned from a Dominican Republic pilot study.

OBJECTIVE: To assess knowledge of the Zika virus (ZIKV), use of contraceptives, and sources of health information in rural communities in the Dominican Republic. METHODS: Over 4 days in March 2017, a research team traveled to four rural communities in the Dominican Republic to provide healthcare services. Overall, 90 men and women consented to a voluntary verbal 12-question survey. RESULTS: Of the participants, 55% were not certain whether ZIKV is transmitted sexually; 75% of participants were either not sure or thought ZIKV was not present in their community. Charlas (informal discussions led by community health workers) were cited as the most common source for public health information. Prevalence of contraceptive use was 26.6% hormonal and 1.1% long-acting reversible contraception (LARC); 30.0% cited no use of contraception. CONCLUSION: Significant deficits in ZIKV knowledge, underutilization of LARCs, and socioeconomic factors exist that constrain the application of WHO recommendations for preventing ZIKV infection. Additional and more robust surveys are needed to assess public health education and interventions, critical for disease prevention in communities facing current and future epidemics.

Canaries in a coalmine: Immigration and overweight among Mexican-origin children in the US and Mexico.

The prevalence of overweight is higher for Hispanic children of immigrants than children of natives. This does not fit the pattern of the epidemiological paradox, the widely supported finding that immigrants tend to be healthier than their U.S.-born peers, and it suggests that exposure to the U.S. increases immigrant children's risk of overweight. This study's primary contribution is to better assess how exposure to the U.S. environment affects childhood overweight among a homogamous ethnic group, Mexican-Americans. We do so by using an innovative binational study design to compare the weight of Mexican-American children of immigrants, Mexican-American children of natives, and Mexican children in Mexico with different propensities of having immigrant parents. Cross-sectional data are derived from a pooled sample of 9982 6-19 year old children living in either Mexico or the United States in the early 2000s. Mexican-resident children with a very high propensity to have immigrant parents have significantly lower percentile BMIs and lower odds of overweight than Mexican children with lower propensities of emigration and U.S.-resident Mexican-American children. This suggests that selection into immigration streams does not account for the high prevalence of overweight among children of Mexican immigrants. Rather, U.S. exposure significantly raises children of Mexican immigrants' risk of being overweight. Moreover, second generation children have the highest percentile BMIs and greatest odds of overweight of all comparison groups, including children of natives. This suggests that they experience risks above and beyond the effects of exposure to American society.

Early initiation of and exclusive breastfeeding in large-scale community-based programmes in Bolivia and Madagascar.

About one-fourth to one-half of all infant deaths in developing countries occur in the first week of life. Immediate breastfeeding within the first hour, followed by early exclusive breastfeeding, improves the health and survival status of newborns. The aim of this study was to demonstrate that breastfeeding practices, crucial to infant health, can be improved at scale in developing countries. During 1999-2003, the LINKAGES Project, funded by the United States Agency for International Development, implemented its community-based model to bring about rapid change in individual behaviours and community norms regarding early and exclusive breastfeeding, at a scale [LINKAGES' definition of 'scale' was adapted from a CORE Group background paper on 'Scaling-up' maternal, newborn, and child health services, 11 July 2005] that could achieve significant public-health impact. 'Scale' was defined as bringing improved infant-feeding practices to more people over a wider geographic area, more quickly, more equitably, and with sustainability as a goal. During this time, country-specific programmes were designed and implemented in Bolivia and Madagascar, with catchment populations of one million and six million respectively. These country programmes were implemented with multiple local government, private voluntary organizations, and partners of non-governmental organizations (NGOs) through existing health and nutrition activities. Breastfeeding was an entry point to work at all levels of the healthcare system and, within communities, using policy/advocacy and training for healthcare workers, with a particular emphasis on front-line health workers and community members. Harmonized messages and materials, including mass media, were developed and used by partners. Timely initiation of breastfeeding was one indicator measured. Data collected through rapid assessment surveys showed statistically significant increases (p<0.001) in timely initiation of breastfeeding in both the countries. In Bolivia, timely initiation of breastfeeding went from 56% in 2000 to 69% in 2001 and reached 74% by the end of 2003. In Madagascar, the initiation rate went from 34% at baseline in 2000 to 69% in 2001, 76% in 2002, and rose to 78% in 2004. Exclusive breastfeeding during the first month of life was also measured. At baseline in Bolivia, the rate of exclusive breastfeeding for the first month of life was 81% (2000), decreased slightly in 2001, and then increased to 88% by the end of the Project in 2003. In Madagascar, it started high at 86% in 2000, increased during the implementation of the programme, and by 2004, was 91%. These results were achieved quickly and sustained over the course of the intervention.