Effectiveness of demand generation interventions on use of modern contraceptives in low- and middle-income countries.

OBJECTIVES: To synthesise evidence on the implementation, costs and cost-effectiveness of demand generation interventions and their effectiveness in improving uptake of modern contraception methods. METHODS: A Cochrane systematic review was conducted. Searches were performed in electronic databases (MEDLINE, EMBASE) and the grey literature. Randomised controlled trials, cluster randomised trials and quasi-experimental studies, including controlled before-after studies (CBAs) and cost and cost-effectiveness studies that aimed to assess demand interventions (including community- and facility-based interventions, financial mechanisms and mass media campaigns) in low- and middle-income countries were considered. Meta-analyses and narrative synthesis were conducted. RESULTS: In total, 20 papers meeting the inclusion criteria were included in this review. Of those, 13 were used for meta-analysis. Few data were available on implementation and on the influence of context on demand interventions. Involving family members during counselling, providing education activities and increasing exposure to those activities could enhance the success of demand interventions. Demand generation interventions were positively associated with increases in current use (pooled OR 1.57; 95% CI: 1.46-1.69, P < 0.01). Financial mechanism interventions (vouchers) appeared effective to increase use of modern contraceptive methods (pooled OR 2.16; 95% CI: 1.91-2.45, P < 0.01; I2 = 0%). Demand interventions improved knowledge (pooled OR 1.02; 95% CI 0.63-1.64, P = 0.93) and attitudes towards family planning and improved discussion with partners/husbands around modern contraceptive methods. However, given the limited number of studies included in each category of demand generation interventions, the dates of publication of the studies and their low quality, caution is advised in considering the results. Very limited evidence was available on costs; studies including data on costs were old and inconsistent. CONCLUSION: Demand generation interventions contribute to increases in modern contraceptive methods use. However, more studies with robust designs are needed to identify the most effective demand generation intervention to increase uptake of modern contraceptive methods. More evidence is also needed about implementation, costs and cost-effectiveness to inform decisions on sustainability and scaling-up.

Photocatalytic degradation of 2,4-dichlorophenoxyacetic acid and 4-chloro-2-methylphenoxyacetic acid in water by using TiO2.

The photocatalytic degradation of many chlorinated organic compounds by semiconductor particles, has been widely recognised as a promising method of water and wastewater treatment process. In the present work the photocatalytic transformation of 2,4-D and MCPA in aqueous solution with 2 g l(-1) suspended TiO2 is demonstrated. The formation of several intermediates has been observed. The photodegradation rate increases with increasing pH. The photocatalytic transformation of 2,4-D and MCPA over TiO2 in solution containing hydrogen peroxide has been also studied. H2O, accelerated significantly the reaction rate of 2, 4-D and MCPA. The partial inhibition by ethanol is attributed to the scavenging of OH radicals involved in the first step of the reaction. Finally, from these results, a mechanism is proposed. This photocatalytic method has good potential for application on a large scale.