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C-Channel Issue 8

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C-Channel header  April 2009

Dear Colleagues,

C-Channel 8, the monthly e-newsletter from the C-Change program, provides peer-reviewed literature with a focus on behavior and social change communication across health areas, in particular HIV and AIDS, family planning and reproductive health, malaria, and antenatal and maternal health care. Eleven articles are summarized in C-Channel 8: five on HIV and AIDS, with two of the articles focused on male circumcision, one of which looked at 13 studies done across nine African countries, considered factors that may influence uptake of circumcision in traditionally non-circumcising populations, and found high levels of men willing to be circumcised and high levels of women and men willing to circumcise sons; two on family planning, one of which looks at family planning knowledge of women and men in refugee camps in Guinea; and three on malaria, two that consider malaria in pregnancy and one that examines seasonal malaria and treatment-seeking behaviors for fever in Ethiopia. The eleven articles cover research carried out in Botswana, Burkina Faso, Ethiopia, Ghana, Guinea, Kenya, Malawi, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, Canada, and Haiti.

C-Change has recently launched a program in the Oromia and Amhara regions of Ethiopia focused on increasing community knowledge of malaria diagnosis, timely seeking of medical treatment, and correct use of treated nets; and promoting active support of indoor spraying. There is also a focus on increasing antenatal care attendance and increased use of prevention-of-mother-to-child transmission of HIV (PMTCT) services by pregnant women. Additional information is available at the program’s website: www.c-changeprogram.org.

Thank you,
The Knowledge Management Team at C-Change


To view archived issues, visit http://c-changeprogram.org/c-channel


HIV and AIDS

1. The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal, South Africa

2. Effects of a culturally adapted HIV prevention intervention in Haitian youth

3. Knowledge of correct condom use and consistency of use among adolescents in four countries in Sub-Saharan Africa

4. Gender differences in university students' HIV/AIDS-related knowledge and sexual behaviours in Malawi: A pilot study

5. Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa

6. Acceptability of male circumcision for prevention of HIV/AIDS in sub-Saharan Africa: A review
 

FAMILY PLANNING/REPRODUCTIVE HEALTH

7. Reproductive health services for refugees by refugees in Guinea I: Family planning

8. The joint influence of marital status, interpregnancy interval, and neighborhood on small for gestational age birth: A retrospective cohort study
 

MALARIA

9. Treatment-seeking behaviour for febrile illness in an area of seasonal malaria transmission in rural Ethiopia

10. Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda

11. Intermittent preventive treatment of malaria in pregnancy: The effect of new delivery approaches on access and compliance rates in Uganda
 


HIV and AIDS

1. The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal, South Africa

Authors: Abdool Karim, Q; Meyer-Weitz, A; Mboyi, L; Carrara, H; Mahlase, G; Frohlich, JA; Abdool Karim, SS
Source: Global Public Health October 2008, 3(4): 351-365.

ABSTRACT

This study aims to understand the influence of AIDS stigma and discrimination, and social cohesion to HIV testing, and willingness to disclose an HIV status. A cross-sectional, interviewer administered survey (N=594) was conducted. Independent sample t-tests explored the mean differences between sex and age groups on stigma, discrimination, and social cohesion measurement. Logistic regression models were fitted with the above independent variables, and the binominal dependent variables: having had a test, willingness to have a test and disclose a positive status. The mean age of participants was 25.3 years and 60% were women. Only 28% had an HIV test, 63% were willing to have a test, and 82% reported a willingness to disclose an HIV status. High levels of stigma and discrimination were anticipated from the community, less so from their partners, and very little from families. Low levels of social distance exist towards people with HIV/AIDS, membership to social networks seems limited, and inadequate social support for people with HIV/AIDS was reported. The analysis indicates that AIDS stigma and discrimination, and inadequate social cohesion, limit access to voluntary counselling and testing (VCT), inhibit disclosure, and are, thus, barriers to care, support and prevention. Interventions need to extend the focus on information and education to strengthen social capital within a participatory and sustainable development framework.

KEYWORDS: AIDS stigma and discrimination, social cohesion, disclosure, VCT

To link to the website containing this article, click here.

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2. Effects of a culturally adapted HIV prevention intervention in Haitian youth

Authors: Malow, RM; Stein, JA; McMahon, RC; Dévieux, JG; Rosenberg, R; Jean-Gilles, M
Source: Journal of Associated Nurses AIDS Care Mar-Apr 2009, 20(2): 110-21. [PubMed]

ABSTRACT

This study assessed the impact of an 8-week community-based translation of Becoming a Responsible Teen (BART), an HIV intervention that has been shown to be effective in other at-risk adolescent populations. A sample of Haitian adolescents living in the Miami area was randomized to a general health education control group (n = 101) or the BART intervention (n = 145), which was based on the information-motivation-behavior (IMB) model. Improvement in various IMB components (i.e., attitudinal, knowledge, and behavioral skills variables) related to condom use was assessed 1 month after the intervention. Longitudinal structural equation models using a mixture of latent and measured multi-item variables indicated that the intervention significantly and positively impacted all IMB variables tested in the model. These BART intervention-linked changes reflected greater knowledge, greater intentions to use condoms in the future, higher safer sex self-efficacy, an improved attitude about condom use, and an enhanced ability to use condoms after the 8-week intervention.

To link to the website containing this article, click here.

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3. Knowledge of correct condom use and consistency of use among adolescents in four countries in Sub-Saharan Africa

Authors: Bankole, A; Ahmed, FH; Neema, S; Ouedraogo, C; Konyani, S
Source: African Journal of Reproductive Health 2007, 11(3): 197–220. [PubMed Central]

ABSTRACT

Using data from the 2004 National Adolescent Surveys, this paper undertook a detail analysis of knowledge of correct condom use and consistency of use, as well as their covariates, among adolescents in Burkina Faso, Ghana, Malawi and Uganda. The strongest predictor of knowledge of correct condom use among both male and female adolescents is exposure to a condom use demonstration. In Burkina Faso, Ghana and Uganda, adolescents who have seen a condom demonstration are 2 to 5 times as likely as those who have not to have good knowledge of correct condom use. Age, ever received sex education in school, ever attended school and exposure to the radio are also significant predictors of knowledge of correct use, particularly among men. As indicated by behavior among young men, the extent to which adolescents use the condom consistently varies across countries. Yet, it is nowhere near the required 100% level. The proportion reporting consistent use of the method in the 3 months preceding the survey is 38% in Burkina Faso, 47% in Ghana, 20% in Malawi and 36% in Uganda. Age difference between partners is a major determinant of consistent use of condoms: young men whose partner is 0–4 years younger are about two and a half times more likely to use condoms consistently than those who whose partner is 5–9 years younger. Other important predictors of consistent condom use are residence, education, living arrangement and exposure to mass media, specifically the radio and newspaper. Findings from this study point to areas that policy and program can address to provide adolescents access to the kinds of information and service they need to achieve healthy sexual and reproductive lives.

KEYWORDS: correct condom use, sex education, adolescents

To link to the website containing this article, click here. Full Text is freely available.

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4. Gender differences in university students' HIV/AIDS-related knowledge and sexual behaviours in Malawi: A pilot study

Authors: Ntata, PR; Muula, AS; Siziya, S; Kayambazinthu, EE
Source: SAHARA Journal Dec 2008, 5(4): 201-5. [PubMed]

ABSTRACT

A cross-sectional study was conducted among first-year university students in Malawi to determine distributions of HIV/AIDS-related knowledge, and sexual behaviours. A total of 314 (199 male and 115 female) students were eligible to participate, and of these 221 (70.4%) participated in the survey. Generally, levels of HIV/AIDS-related knowledge were similar between sexes. Overall, 68.9% of students of both sexes felt that they knew enough about HIV/AIDS. Altogether, 83.3% of students reported that they knew where to access HIV testing on campus, but only 19.0% reported that they knew their HIV status. Some 60.3% of students who had never been tested intended to have an HIV test. A history of having ever been tested was not associated with sex. Most (68.4%) students felt that they were not at risk of acquiring HIV infection. Overall, 66.8% of students knew where to get a condom on campus, and 38.7% stated that they knew exactly how to use it. About half (52.6%) of the students used a condom at last vaginal sexual intercourse. Having multiple sex partners in the last 12 months was reported by 40.4% of students.

To link to the website containing this article, click here. Full Text is freely available.

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5. Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa

Authors : Nagelkerke, NJD; Moses, S; de Vlas, SJ; Bailey, RC
Source: BMC Infectious Diseases 13 March 2007, 7:16.

ABSTRACT

BACKGROUND: Recent clinical trials in Africa, in combination with several observational epidemiological studies, have provided evidence that male circumcision can reduce HIV female-to-male transmission risk by 60% or more. However, the public health impact of large-scale male circumcision programs for HIV prevention is unclear.

METHODS: Two mathematical models were examined to explore this issue: a random mixing model and a compartmental model that distinguishes risk groups associated with sex work. In the compartmental model, two scenarios were developed, one calculating HIV transmission and prevalence in a context similar to the country of Botswana, and one similar to Nyanza Province, in western Kenya.

RESULTS: In both models, male circumcision programs resulted in large and sustained declines in HIV prevalence over time among both men and women. Men benefited somewhat more than women, but prevalence among women was also reduced substantially. With 80% male circumcision uptake, the reductions in prevalence ranged from 45% to 67% in the two "countries", and with 50% uptake, from 25% to 41%. It would take over a decade for the intervention to reach its full effect.

CONCLUSIONS: Large-scale uptake of male circumcision services in African countries with high HIV prevalence, and where male circumcision is not now routinely practised, could lead to substantial reductions in HIV transmission and prevalence over time among both men and women.

To link to the website containing this article, click here. Full Text is freely available.

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6. Acceptability of male circumcision for prevention of HIV/AIDS in sub-Saharan Africa: A review

Authors: Westercamp, N; Bailey, RC
Source: AIDS and Behavior May 2007, 11(3): 341-355. [PubMed Central]

ABSTRACT

Based on epidemiological, clinical and experimental evidence, male circumcision (MC) could have a significant impact on the HIV epidemic in selected areas. We reviewed studies of the acceptability of MC in sub-Saharan Africa to assess factors that will influence uptake of circumcision in traditionally non-circumcising populations. Thirteen studies from nine countries were identified. Across studies, the median proportion of uncircumcised men willing to become circumcised was 65% (range 29–87%). Sixty nine percent (47–79%) of women favored circumcision for their partners, and 71% (50–90%) of men and 81% (70–90%) of women were willing to circumcise their sons. Because the level of acceptability across the nine countries was quite consistent, additional acceptability studies that pose hypothetical questions to participants are unnecessary. We recommend pilot interventions making safe circumcision services available in conjunction with current HIV prevention strategies and evaluating the safety and acceptability of circumcision.

KEYWORDS: Male circumcision, Acceptability, HIV-1, Africa

To link to the website containing this article, click here. Full Text is freely available.

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FAMILY PLANNING/REPRODUCTIVE HEALTH

7. Reproductive health services for refugees by refugees in Guinea I: Family planning

Authors:Howard, N; Kollie, S; Souare, Y; von Roenne, A; Blankhart, D; Newey, C; Chen, MI; Borchert, M
Source: Conflict and Health 2008, 2:12. [BioMed Central]

ABSTRACT

BACKGROUND: Comprehensive studies of family planning (FP) in refugee camps are relatively uncommon. This paper examines gender and age differences in family planning knowledge, attitudes, and practices among Sierra Leonean and Liberian refugees living in Guinea.

METHODS: In 1999, a cross-sectional survey was conducted of 889 reproductive-age men and women refugees from 48 camps served by the refugee-organised Reproductive Health Group (RHG). Sampling was multi-stage with data collected for socio-demographics, family planning, sexual health, and antenatal care. Statistics were calculated for selected indicators.

RESULTS: Women knew more about FP, although men's education reduced this difference. RHG facilitators were the primary source of reproductive health information for all respondents. However, more men then women obtained information from non-health sources, such as friends and media. Approval of FP was high, significantly higher in women than in men (90% vs. 70%). However, more than 40% reported not having discussed FP with their partner. Perceived service quality was an important determinant in choosing where to get contraceptives. Contraceptive use in the camps served by RHG was much higher than typical for either refugees' country of origin or the host country (17% vs. 3.9 and 4.1% respectively), but the risk of unwanted pregnancy remained considerable (69%).

CONCLUSION: This refugee self-help model appeared largely effective and could be considered for reproductive health needs in similar settings. Having any formal education appeared a major determinant of FP knowledge for men, while this was less noticeable for women. Thus, FP communication strategies for refugees should consider gender-specific messages and channels.

To link to the website containing this article, click here. Full Text is freely available.

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8. The joint influence of marital status, interpregnancy interval, and neighborhood on small for gestational age birth: A retrospective cohort study

Authors: Auger, N; Daniel, M; Platt, RW; Luo, ZC; Wu, Y; Choinière, R
Source: BMC Pregnancy Childbirth 2008, 8:7.

ABSTRACT

BACKGROUND: Interpregnancy interval (IPI), marital status, and neighborhood are independently associated with birth outcomes. The joint contribution of these exposures has not been evaluated. We tested for effect modification between IPI and marriage, controlling for neighborhood.

METHODS: We analyzed a cohort of 98,330 live births in Montréal, Canada from 1997–2001 to assess IPI and marital status in relation to small for gestational age (SGA) birth. Births were categorized as subsequent-born with short (<12 months), intermediate (12–35 months), or long (36+ months) IPI, or as firstborn. The data had a 2-level hierarchical structure, with births nested in 49 neighborhoods. We used multilevel logistic regression to obtain adjusted effect estimates.

RESULTS: Marital status modified the association between IPI and SGA birth. Being unmarried relative to married was associated with SGA birth for all IPI categories, particularly for subsequent births with short (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.31–1.95) and intermediate (OR 1.48, 95% CI 1.26–1.74) IPIs. Subsequent births had a lower likelihood of SGA birth than firstborns. Intermediate IPIs were more protective for married (OR 0.50, 95% CI 0.47–0.54) than unmarried mothers (OR 0.65, 95% CI 0.56–0.76).

CONCLUSION: Being unmarried increases the likelihood of SGA birth as the IPI shortens, and the protective effect of intermediate IPIs is reduced in unmarried mothers. Marital status should be considered in recommending particular IPIs as an intervention to improve birth outcomes.

To link to the website containing this article, click here. Full Text is freely available.

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MALARIA

9. Treatment-seeking behaviour for febrile illness in an area of seasonal malaria transmission in rural Ethiopia

Author: Deressa, W
Source: Malaria Journal 2007, 6:49.

ABSTRACT

BACKGROUND: Very little is known about the management of malaria and treatment-seeking patterns among children and adults in areas of seasonal malaria transmission particularly in east Africa.

OBJECTIVES: The aim of this study was to assess treatment-seeking behaviour for reported malaria among all age groups in an area of seasonal transmission.

METHODS: A community-based cross-sectional study was carried out among 2,253 households in 12 randomly selected rural kebeles in Adami Tulu district in south-central Ethiopia, during October-November 2003, using a pre-tested interviewer-administered structured questionnaire.

RESULTS: Reported malaria was 14% among 12,225 people assessed during the last 14 days. Family/self-diagnosis was most common and the main first responses included visiting village-based community health workers (CHWs) (33%), public health facility (23%) and private clinic (17%). Home treatment was the least reported first response (3%). Only 13% had sought treatment within the first 24 hours of symptom onset. Early treatment-seeking pattern was reported among those who visited CHWs and practiced home treatment, with more delays among public facility users. Treatment-seeking behaviour was similar in all age groups.

CONCLUSION: A considerable proportion of visits were made to CHWs and private providers, necessitating the importance of strengthening both community-based interventions and peripheral public and private facilities. Finally, the community should be informed and educated about the importance of early diagnosis and prompt treatment with effective antimalarials.

To link to the website containing this article, click here. Full Text is freely available.

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10. Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda

Authors: Kiwuwa, MS; Mufubenga, P
Source: Malaria Journal 2008, 7:44.

ABSTRACT

BACKGROUND: To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Uganda improved the antenatal care package by including a strong commitment to increase distribution of insecticide-treated nets (ITNs) and introduction of intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) as a national policy in 2000. This study assessed uptake of both ITNs and IPTp-SP by pregnant women as well as antenatal and maternity care use with the aim of optimizing their delivery.

METHODS: 769 post-partum women were recruited from a rural area of central Uganda with perennial malaria transmission through a cross-sectional, community-based household survey in May 2005.

RESULTS: Of the 769 women interviewed, antenatal clinic (ANC) attendance was high (94.4%); 417 (57.7%) visiting initially during the 2nd trimester, 242 (33.5%) during the 3rd trimester and 266 (37.1%) reporting > or = 4 ANC visits. About 537 (71%) and 272 (35.8%) received one or > or = 2 IPTp-SP doses respectively. Only 85 (15.8%) received the first dose of IPTp-SP in the 3rd trimester. ITNs were used by 239 (31.3%) of women during pregnancy and 314 (40.8%) delivered their most recent pregnancy outside a health facility. Post-partum women who lacked post-primary education were more likely not to have attended four or more ANC visits (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.2-9.3).

CONCLUSION: These findings illustrate the need to strengthen capacity of the district to further improve antenatal care and maternity services utilization and IPTp-SP uptake. More specific and effective community health strategies to improve effective ANC, maternity services utilization and IPTp-SP uptake in rural communities should be undertaken.

To link to the website containing this article, click here. Full Text is freely available.

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11. Intermittent preventive treatment of malaria in pregnancy: The effect of new delivery approaches on access and compliance rates in Uganda

Authors: Mbonye, AK; Magnussen, P; Bygbjerg, IB
Source: Tropical Medicine and International Health April 2007, 12(4): 519-31.

ABSTRACT

OBJECTIVE: To assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer intermittent preventive treatment (IPT) with sulfadoxine-pyremethamine to pregnant women, and reach those most at risk of malaria and increase access and compliance to it.

METHODS: The study was designed to assess new approaches of delivering IPT through these groups and compare it with IPT at health units. The primary outcome measures were: the proportion of adolescents and primigravidae accessed; gestational age at recruitment and the proportion of women who completed two doses of sulfadoxine-pyremethamine.

RESULTS: Two thousand seven hundred and eighty-five pregnant women (78% of those in the study area) participated. With new approaches, 92.4% of the women received IPT during the second trimester as recommended by the policy, vs. 76.1% at health units, P < 0.0001. Of the women who received two doses of sulfadoxine-pyremethamine, 39.9% were at health units (control) vs. 67.5% through new approaches (P < 0.0001). Women using the new approaches also accessed IPT early: the mean gestational age when receiving the first dose of sulfadoxine-pyremethamine was 21.0 weeks vs. 23.1 weeks at health units (P < 0.0001). However, the health units were used by a higher proportion of primigravidae (23.6% vs. 20.0%, P < 0.04), and this was also the case for adolescents (28.4% vs. 25.0%, P < 0.03). This intervention was acceptable with 89.1% of the women at the new approaches intending to use IPT in future.

CONCLUSIONS: The new approaches increased access to and compliance with IPT. We recommend a review of the policy to allow the provision of IPT through the new approaches.

To link to the website containing this article, click here. Full Text is freely available.

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C-Change, managed by AED, is USAID's flagship program to improve the effectiveness and sustainability of communication programs for behavior and social change in low and middle income countries.
To contact us, please send an email to c-channel@healthnet.org
Additional information about the project is available at the website www.c-changeprogram.org/