1
|
Evans L, Lund C, Massazza A, Weir H, Fuhr DC. The impact of employment programs on common mental disorders: A systematic review. Int J Soc Psychiatry 2022; 68:1315-1323. [PMID: 35796434 PMCID: PMC9548920 DOI: 10.1177/00207640221104684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While employment programs were not created with the intent to improve common mental disorders (CMDs), they may have a positive impact on the prevalence, incidence, and severity of CMD by reducing poverty and increasing access to economic mobility. AIM To examine and synthesize the available quantitative evidence of the impact of employment programs on outcomes of CMD. METHODS Embase, Econlit, Global Health, MEDLINE, APA PsychINFO, and Social Policy and Practice were searched for experimental and quasi-experimental studies which investigated the impact of employment programs on primary and secondary outcomes of a CMD. A narrative synthesis according to Popay was conducted. The methodological quality of studies was assessed with the Cochrane Risk of Bias tool and the Newcastle-Ottawa Assessment Scale. RESULTS Of the 1,327 studies retrieved, two randomized controlled trials, one retrospective cohort, one pilot study with a non-randomized experimental design, and one randomized field experiment were included in the final review. Employment programs generally included multiple components such as skills-based training, and hands-on placements. Depression and anxiety were the CMDs measured as primary or secondary outcomes within included studies. Findings regarding the impact of employment programs on CMD were mixed with two studies reporting significantly positive effects, two reporting no effects, and one reporting mixed effects. The quality among included studies was good overall with some concerns regarding internal validity. CONCLUSION Employment programs may support a decrease in the prevalence, incidence, and severity of CMDs. However, there is high heterogeneity among study effects, designs, and contexts. More research is needed to gain further insight into the nature of this association and the mechanisms of impact. This review highlights the potential for employment programs and other poverty-reduction interventions to be utilized and integrated into the wider care, prevention, and treatment of common-mental disorders.
Collapse
Affiliation(s)
- Libby Evans
- Department of Health Services Research
and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Crick Lund
- Centre for Global Mental Health, Health
Services and Population Research Department, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, UK
- Department of Psychiatry and Mental
Health, Alan J. Fisher Centre for Public Mental Health, University of Cape Town,
South Africa
| | - Alessandro Massazza
- Department of Health Services Research
and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Hannah Weir
- Department of Health Services Research
and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Daniela C Fuhr
- Department of Health Services Research
and Policy, London School of Hygiene and Tropical Medicine, UK
| |
Collapse
|
2
|
Microcredit Membership and Self-Reported Healthcare Autonomy among Bangladeshi Women. WOMEN 2022. [DOI: 10.3390/women2030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Participation in microcredit programs has so far received widespread research and policy attention in the context of health and empowerment among Bangladeshi women. However, not much is known regarding the relationship between participation in microcredit programs and healthcare autonomy (HA) among women. In the present study, we analyzed two nationally representative surveys (Bangladesh Demographic and Health Survey 2004 and 2014), to assess the relationships between MC membership and HA among adult women (n = 29163), while adjusting for various sociodemographic correlates. Self-reported healthcare decision-making autonomy was assessed by asking whether or not the participant had final say on her healthcare. The findings revealed that between 2004 (20.9%, 95%CI = 19.8, 22.0) and 2014 (14.1%, 95%CI = 13.3, 15.0), the proportion of women reporting HA decreased significantly, despite considerable improvements across several socioeconomic indices, including higher education enrollment and labor market participation. Between 2004 and 2014, the percentage of microcredit borrowers decreased for Grameen (18.9% vs. 10.7%) and BRAC (7.9% vs. 7.4%), while it increased for BRDB (0.9% vs. 7.0%). A multivariate regression analysis revealed that Grameen Bank membership was positively associated with reporting HA in both male- (OR = 1.16, 95%CI = 1.09, 1.23) and female-headed households (OR = 1.44, 95%CI = 1.13, 1.85). A positive association between microcredit membership and HA was also observed for BRAC (OR = 1.33, 95%CI = 1.20, 1.47) and BRDB (OR = 1.18, 95%CI = 1.09, 1.29), but in the male-headed households only. Further analysis indicated that membership with Grameen bank was the most important predictor of HA, followed by BRAC, BRDB, and ASA, with the degree of importance varying substantially between male- and female-headed households. In conclusion, these findings suggest the potential of microcredit programs to promote healthcare autonomy among Bangladeshi women and provide insights for further research, as to why certain programs are more effective than others.
Collapse
|
3
|
Desai S, Mehta KM, Singh RJ, Westley AK, Dirisu O, Wong C, De Hoop T, Darmstadt GL. Effects of integrated economic and health interventions with women's groups on health-related knowledge, behaviours and outcomes in low-income and middle-income countries: a systematic review protocol. BMJ Open 2021; 11:e046856. [PMID: 34253668 PMCID: PMC8276287 DOI: 10.1136/bmjopen-2020-046856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Economic groups, such as microfinance or self-help groups are widely implemented in low-income and middle-income countries (LMICs). Women's groups are voluntary groups, which aim to improve the well-being of members through activities, such as joint savings, credit, livelihoods development and/or health activities. Health interventions are increasingly added on to existing women's economic groups as a public health intervention for women and their families. Here, we present the protocol for a mixed-methods systematic review we will conduct of the evidence on integrated economic and health interventions on women's groups to assess whether and how they improve health-related knowledge, behaviour and outcomes in LMICs. METHODS AND ANALYSIS We will search seven electronic databases for published literature, along with manual searches and consultation. The review will include (1) randomised trials and non-randomised quasiexperimental studies of intervention effects of integrated economic and health interventions delivered through women's groups in LMICs, and (2) sibling studies that examine factors related to intervention content, context, implementation processes and costs. We will appraise risk of bias and study quality using standard tools. High and moderate quality studies will be grouped by health domain and synthesised without meta-analysis. Qualitative evidence will be thematically synthesised and integrated into the quantitative synthesis using a matrix approach. ETHICS AND DISSEMINATION This protocol was reviewed and deemed exempt by the institutional review board at the American Institutes for Research. Findings will be shared through peer-reviewed publication and disseminated with programme implementers and policymakers engaged with women's groups. PROSPERO REGISTRATION NUMBER CRD42020199998.
Collapse
Affiliation(s)
- Sapna Desai
- Population Council India, New Delhi, Delhi, India
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | | | | | - Connie Wong
- Lane Medical Library, Stanford University School of Medicine, Stanford, California, USA
| | - Thomas De Hoop
- International Development Division, American Institutes for Research, Washington, DC, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
4
|
Dong R, Leung C, Naert MN, Naanyu V, Kiptoo P, Matelong W, Matini E, Orango V, Bloomfield GS, Edelman D, Fuster V, Manyara S, Menya D, Pastakia SD, Valente T, Kamano J, Horowitz CR, Vedanthan R. Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya. PLoS One 2021; 16:e0248496. [PMID: 34097700 PMCID: PMC8183981 DOI: 10.1371/journal.pone.0248496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known. METHODS Two types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes. RESULTS We conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. In the context of poverty and previous experiences with the health system, participants described challenges to NCD care across three themes: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility. However, they also outlined windows of opportunity and facilitators of group medical visits and microfinance to address those challenges. DISCUSSION Our qualitative study revealed actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also described opportunities to address and mitigate the impact of these factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide.
Collapse
Affiliation(s)
- Rae Dong
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Claudia Leung
- Duke University Medical Center, Durham, North Carolina, United States of America
| | - Mackenzie N. Naert
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Winnie Matelong
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Esther Matini
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Gerald S. Bloomfield
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - David Edelman
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Simon Manyara
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Sonak D. Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, West Lafayette, Indiana, United States of America
| | - Tom Valente
- Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Jemima Kamano
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - Carol R. Horowitz
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Rajesh Vedanthan
- NYU Grossman School of Medicine, New York, NY, United States of America
| |
Collapse
|
5
|
Gram L, Desai S, Prost A. Classroom, club or collective? Three types of community-based group intervention and why they matter for health. BMJ Glob Health 2021; 5:bmjgh-2020-003302. [PMID: 33328198 PMCID: PMC7745328 DOI: 10.1136/bmjgh-2020-003302] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Interventions involving groups of laywomen, men and adolescents to promote health are increasingly popular, but past research has rarely distinguished between different types of intervention with groups. We introduce a simple typology that distinguishes three ideal types: classrooms, clubs and collectives. Classrooms treat groups as a platform for reaching a population with didactic behaviour change strategies. Clubs seek to build, strengthen and leverage relationships between group members to promote health. Collectives engage whole communities in assuming ownership over a health problem and taking action to address it. We argue that this distinction goes a long way towards explaining differences in achievable health outcomes using interventions with groups. First, classrooms and clubs are appropriate when policymakers primarily care about improving the health of group members, but collectives are better placed to achieve population-level impact. Second, classroom interventions implicitly assume bottleneck behaviours preventing a health outcome from being achieved can be reliably identified by experts, whereas collectives make use of local knowledge, skill and creativity to tackle complexity. Third, classroom interventions assume individual participants can address health issues largely on their own, while clubs and collectives are required to engender collective action in support of health. We invite public health researchers and policymakers to use our framework to align their own and communities’ ambitions with appropriate group-based interventions to test and implement for their context. We caution that our typology is meant to apply to groups of laypeople rather than professionalised groups such as whole civil society organisations.
Collapse
Affiliation(s)
- Lu Gram
- Institute for Global Health, Department of Population Health Sciences, University College London, London, UK
| | - Sapna Desai
- Population Council India, New Delhi, Delhi, India
| | - Audrey Prost
- Institute for Global Health, Department of Population Health Sciences, University College London, London, UK
| |
Collapse
|
6
|
Vedanthan R, Kamano JH, Chrysanthopoulou SA, Mugo R, Andama B, Bloomfield GS, Chesoli CW, DeLong AK, Edelman D, Finkelstein EA, Horowitz CR, Manyara S, Menya D, Naanyu V, Orango V, Pastakia SD, Valente TW, Hogan JW, Fuster V. Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya. J Am Coll Cardiol 2021; 77:2007-2018. [PMID: 33888251 PMCID: PMC8065205 DOI: 10.1016/j.jacc.2021.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746).
Collapse
Affiliation(s)
- Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, New York, USA.
| | - Jemima H Kamano
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | | | - Eric A Finkelstein
- Duke University, Durham, North Carolina, USA; Duke-National University of Singapore Medical School, Singapore
| | - Carol R Horowitz
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Simon Manyara
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Diana Menya
- School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
7
|
Ahmad D, Mohanty I, Hazra A, Niyonsenga T. The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program. BMC Pregnancy Childbirth 2021; 21:79. [PMID: 33485310 PMCID: PMC7824939 DOI: 10.1186/s12884-021-03563-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. While health system reforms in India prioritised institutional deliveries, inadequate antenatal and postnatal services limit the knowledge of danger signs of obstetric complications to women, which delays the recognition of complications and seeking appropriate health care. Recently, a novel rapidly scalable community-based program combining maternal health literacy delivery through microfinance-based women-only self-help groups (SHG) was implemented in rural India. This study evaluates the impact of the integrated microfinance and health literacy (IMFHL) program on the knowledge of maternal danger signs in marginalised women from one of India's most populated and poorer states - Uttar Pradesh. Additionally, the study evaluates the presence of a diffusion effect of the knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. METHODS Secondary data from the IMFHL program comprising 17,232 women from SHG and non-member households in rural Uttar Pradesh was included. Multivariate logistic regression models were used to identify the program's effects on the knowledge of maternal danger signs adjusting for a comprehensive range of confounders at the individual, household, and community level. RESULTS SHG member women receiving health literacy were 27% more likely to know all danger signs as compared with SHG members only. Moreover, the results showed that the SHG network facilitates diffusion of knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. The study found that the magnitude of the program impact on outcome remained stable even after controlling for other confounding effects suggesting that the health message delivered through the program reaches all women uniformly irrespective of their socioeconomic and health system characteristics. CONCLUSIONS The findings can guide community health programs and policy that seek to impact maternal health outcomes in low resource settings by demonstrating the differential impact of SHG alone and SHG plus health literacy on maternal danger sign knowledge.
Collapse
Affiliation(s)
- Danish Ahmad
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia.
- Public Health Foundation of India, and Indian Institute of Public Health-Gandhinagar (IIPH-G), New Delhi and Gandhinagar, India.
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| |
Collapse
|
8
|
Jafree SR, Zakar R, Ahsan H, Mustafa M, Fischer F. Impact of microfinance health interventions on health-related outcomes among female informal workers in Pakistan: a retrospective quasi-experimental study. BMJ Open 2021; 11:e043544. [PMID: 33402411 PMCID: PMC7786800 DOI: 10.1136/bmjopen-2020-043544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/02/2020] [Accepted: 12/11/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The purpose of this study is to assess the impact of microfinance health interventions (health insurance and health-awareness programmes) on health-related outcomes among female informal workers in Pakistan. DESIGN We conducted a retrospective, quasi-experimental study among a total of 442 female borrowers from seven microfinance providers (MFPs) across four provinces of Pakistan in 2018. A standardised tool was used for data collection. Probit regression was used to identify the probability of female borrowers gaining improvements in health outcomes based on their sociodemographic characteristics. Propensity score matching (PSM) was used to assess the overall impact of health interventions. PRIMARY OUTCOME MEASURES Four health-related outcomes reported by the women were used: perception of good health overall, ability to visit a general practitioner, ability to purchase prescribed medicine and intake of multivitamins. RESULTS We found that women receiving health interventions had a greater probability of better health outcomes when they were from Punjab province, borrowing in groups and attending monthly meetings at MFPs. Even with a small loan amount, all four health-related outcomes were significantly associated with receiving health insurance and health-awareness programmes. PSM results show a greater likelihood of overall perceived good health (nearest neighbour matching (NNM) =17.4%; kernel matching (KM) =11.8%) when health insurance is provided and a significant improvement in the ability to purchase prescribed medicine when a health-awareness programme is provided (NNM=10.1%; KM=11.7%). CONCLUSION Health and social policies are vital to secure health and well-being among poor women working in the informal sector. Targeting improved equity across female population groups for health interventions will in the long run improve poor women's health, income-earning abilities and capacity expansion for small businesses.
Collapse
Affiliation(s)
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of Lahore, Lahore, Pakistan
| | - Humna Ahsan
- Department of Economics, Forman Christian College, Lahore, Pakistan
| | - Mudasir Mustafa
- Department of Sociology, Social Work, and Anthropology, Utah State University, Logan, Utah, USA
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, University of Applied Sciences Ravensburg-Weingarten, Weingarten, Germany
| |
Collapse
|
9
|
Mehta KM, Irani L, Chaudhuri I, Mahapatra T, Schooley J, Srikantiah S, Abdalla S, Ward V, Carmichael SL, Bentley J, Creanga A, Wilhelm J, Tarigopula UK, Bhattacharya D, Atmavilas Y, Nanda P, Weng Y, Pepper KT, Darmstadt GL. Health layering of self-help groups: impacts on reproductive, maternal, newborn and child health and nutrition in Bihar, India. J Glob Health 2020; 10:021007. [PMID: 33425331 PMCID: PMC7759023 DOI: 10.7189/jogh.10.021007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Self-help group (SHG) interventions have been widely studied in low and middle income countries. However, there is little data on specific impacts of health layering, or adding health education modules upon existing SHGs which were formed primarily for economic empowerment. We examined three SHG interventions from 2012-2017 in Bihar, India to test the hypothesis that health-layering of SHGs would lead to improved health-related behaviours of women in SHGs. METHODS A model for health layering of SHGs - Parivartan - was developed by the non-governmental organisation (NGO), Project Concern International, in 64 blocks of eight districts. Layering included health modules, community events and review mechanisms. The health layering model was adapted for use with government-led SHGs, called JEEViKA+HL, in 37 other blocks of Bihar. Scale-up of government-led SHGs without health layering (JEEViKA) occurred contemporaneously in 433 other blocks, providing a natural comparison group. Using Community-based Household Surveys (CHS, rounds 6-9) by CARE India, 62 reproductive, maternal, newborn and child health and nutrition (RMNCHN) and sanitation indicators were examined for SHGs with health layering (Pavivartan SHGs and JEEViKA+HL SHGs) compared to those without. We calculated mean, standard deviation and odds ratios of indicators using surveymeans and survey logistic regression. RESULTS In 2014, 64% of indicators were significantly higher in Parivartan members compared to non-members residing in the same blocks. During scale up, from 2015-17, half (50%) of indicators had significantly higher odds in health layered SHG members (Parivartan or JEEViKA+HL) in 101 blocks compared to SHG members without health layering (JEEViKA) in 433 blocks. CONCLUSIONS Health layering of SHGs was demonstrated by an NGO-led model (Parivartan), adapted and scaled up by a government model (JEEViKA+HL), and associated with significant improvements in health compared to non-health-layered SHGs (JEEViKA). These results strengthen the evidence base for further layering of health onto the SHG platform for scale-level health change. STUDY REGISTRATION ClinicalTrials.gov number NCT02726230.
Collapse
Affiliation(s)
- Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | - Indrajit Chaudhuri
- Project Concern International, Delhi, India and San Diego, California, USA
| | | | - Janine Schooley
- Project Concern International, Delhi, India and San Diego, California, USA
| | | | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Victoria Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andreea Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jess Wilhelm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Priya Nanda
- Bill and Melinda Gates Foundation, Delhi, India
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
10
|
Rosenberg M, Amisi JA, Szkwarko D, Tran DN, Genberg B, Luetke M, Kianersi S, Namae J, Laktabai J, Pastakia S. The relationship between a microfinance-based healthcare delivery platform, health insurance coverage, health screenings, and disease management in rural Western Kenya. BMC Health Serv Res 2020; 20:868. [PMID: 32928198 PMCID: PMC7491169 DOI: 10.1186/s12913-020-05712-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Structural barriers often prevent rural Kenyans from receiving healthcare and diagnostic testing. The Bridging Income Generation through grouP Integrated Care (BIGPIC) Family intervention facilitates microfinance groups, provides health screenings and treatment, and delivers education about health insurance coverage to address some of these barriers. This study evaluated the association between participation in BIGPIC microfinance groups and health screening/disease management outcomes. METHODS From November 2018 to March 2019, we interviewed a sample of 300 members of two rural communities in Western Kenya, 100 of whom were BIGPIC microfinance members. We queried participants about their experiences with health screening and disease management for HIV, diabetes, hypertension, tuberculosis, and cervical cancer. We used log-binomial regression models to estimate the association between microfinance membership and each health outcome, adjusting for key covariates. RESULTS Microfinance members were more likely to be screened for most of the health conditions we queried, including those provided by BIGPIC [e.g. diabetes: aPR (95% CI): 3.46 (2.60, 4.60)] and those not provided [e.g. cervical cancer: aPR (95% CI): 2.43 (1.21, 4.86)]. Microfinance membership was not significantly associated with health insurance uptake and disease management outcomes. CONCLUSIONS In rural Kenya, a microfinance program integrated with healthcare delivery may be effective at increasing health screening. Interventions designed to thoughtfully and sustainably address structural barriers to healthcare will be critical to improving the health of those living in low-resource settings.
Collapse
Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, Indiana, USA.
| | - James Akiruga Amisi
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya.,Department of Family Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Daria Szkwarko
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya.,Department of Family Medicine and Community Health, The University of Massachusetts Medical School, Worcester, MA, USA.,Department of Family Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Dan N Tran
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya.,Purdue Kenya Partnership, Purdue University College of Pharmacy, Eldoret, Kenya
| | - Becky Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Maya Luetke
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, Indiana, USA
| | - Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, Indiana, USA
| | - Jane Namae
- Webuye Health and Demographic Surveillance System, Moi University, Eldoret, Kenya
| | - Jeremiah Laktabai
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya.,Department of Family Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Sonak Pastakia
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya.,Purdue Kenya Partnership, Purdue University College of Pharmacy, Eldoret, Kenya
| |
Collapse
|
11
|
Mhando F, Dovel K, Jennings Mayo-Wilson L, Rwehumbiza D, Thompson N, Nwaozuru U, Rehani A, Iwelunmor J, Nelson LE, Conserve DF. Microfinance and Peer Health Leadership Intervention Implementation for Men in Dar es Salaam, Tanzania: A Qualitative Assessment of Perceived Economic and Health Outcomes. Am J Mens Health 2020; 14:1557988320936892. [PMID: 32627650 PMCID: PMC7492860 DOI: 10.1177/1557988320936892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022] Open
Abstract
Men in sub-Saharan Africa continue to experience health disparities that are exacerbated by low employment. This study qualitatively assessed men's perceptions of the economic and health-care-seeking effects of participation in an integrated microfinance and peer health leadership intervention on violence and HIV risk reduction in Tanzania. Three focus group discussions with 27 men, aged 20 to 44 years, examined the perceived effects on income generation, employability, mental health, and uptake of HIV and related health services. All discussions were recorded, transcribed, and analyzed using deductive and inductive coding methods. Men reported that the benefits of the intervention included increased employability and income-earning activities due to greater access to entrepreneurial training, low-interest microfinancing, and male-oriented group supports to start or strengthen their businesses. Increased wages through business or other forms of employment were also attributed to men's lower anxiety and distress as financial providers for their families. However, men indicated that apart from the uptake of free HIV testing services, there was limited change in overall health-care-seeking behavior given the high clinic fees and lost time to earn income when attending routine health visits. Men recommended that future microfinance and health promotion interventions provide larger loan amounts, less frequent repayment intervals, and access to health and social insurance. Microfinance and peer health leadership interventions may help to address economic and health disparities in poor, urban men. Efforts are needed to assist lower income men in accessing financial tools as well as fee-based preventive and health-care services.
Collapse
Affiliation(s)
- Frank Mhando
- Department of Geography,
University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Kathryn Dovel
- Division of Infectious Diseases,
David Geffen School of Medicine, University of California Los Angeles
(UCLA), Los Angeles, USA
| | - Larissa Jennings Mayo-Wilson
- Department of Applied Health
Science, Indiana University School of Public Health, Bloomington, IN,
USA
- Department of International
Health, Johns Hopkins University School of Public Health, Baltimore, MD,
USA
| | | | - Noah Thompson
- Department of Health Promotion,
Education, and Behavior, University of South Carolina, Columbia, SC,
USA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science
and Health Education, Saint Louis University, Saint Louis, MO, USA
| | | | - Juliet Iwelunmor
- Department of Behavioral Science
and Health Education, Saint Louis University, Saint Louis, MO, USA
| | | | - Donaldson Fadael Conserve
- Department of Health Promotion,
Education, and Behavior, University of South Carolina, Columbia, SC,
USA
| |
Collapse
|
12
|
Leung CL, Naert M, Andama B, Dong R, Edelman D, Horowitz C, Kiptoo P, Manyara S, Matelong W, Matini E, Naanyu V, Nyariki S, Pastakia S, Valente T, Fuster V, Bloomfield GS, Kamano J, Vedanthan R. Human-centered design as a guide to intervention planning for non-communicable diseases: the BIGPIC study from Western Kenya. BMC Health Serv Res 2020; 20:415. [PMID: 32398131 PMCID: PMC7218487 DOI: 10.1186/s12913-020-05199-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Non-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. Local culture and context can impact the success of interventions and should be integrated early in intervention design. Human-centered design (HCD) is a methodology that can be used to engage stakeholders in intervention design and evaluation to tailor-make interventions to meet their specific needs. METHODS We created a Design Team of health professionals, patients, microfinance officers, community health workers, and village leaders. Over 6 weeks, the Design Team utilized a four-step approach of synthesis, idea generation, prototyping, and creation to develop an integrated microfinance-group medical visit model for NCD. We tested the intervention with a 6-month pilot and conducted a feasibility evaluation using focus group discussions with pilot participants and community members. RESULTS Using human-centered design methodology, we designed a model for NCD delivery that consisted of microfinance coupled with monthly group medical visits led by a community health educator and a rural clinician. Benefits of the intervention included medication availability, financial resources, peer support, and reduced caregiver burden. Critical concerns elicited through iterative feedback informed subsequent modifications that resulted in an intervention model tailored to the local context. CONCLUSIONS Contextualized interventions are important in settings with multiple barriers to care. We demonstrate the use of HCD to guide the development and evaluation of an innovative care delivery model for NCDs in rural Kenya. HCD can be used as a framework to engage local stakeholders to optimize intervention design and implementation. This approach can facilitate the development of contextually relevant interventions in other low-resource settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015.
Collapse
Affiliation(s)
- Claudia L. Leung
- Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710 USA
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St. 3rd floor, Durham, NC 27701 USA
| | - Mackenzie Naert
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Benjamin Andama
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Rae Dong
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - David Edelman
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St. 3rd floor, Durham, NC 27701 USA
| | - Carol Horowitz
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Simon Manyara
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Winnie Matelong
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Esther Matini
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Violet Naanyu
- Department of Behavioral Sciences, School of Medicine, College of Health Science, Moi University College of Health Sciences, Eldoret, Kenya
| | - Sarah Nyariki
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Sonak Pastakia
- Purdue University, Purdue University College of Pharmacy, Purdue-Kenya Partnership, West Lafayette, IN, PO Box 5760, Eldoret, 30100 Kenya
| | - Thomas Valente
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Gerald S. Bloomfield
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Jemima Kamano
- Department of Behavioral Sciences, School of Medicine, College of Health Science, Moi University College of Health Sciences, Eldoret, Kenya
| | - Rajesh Vedanthan
- New York University Grossman School of Medicine, 180 Madison Avenue, 8th Floor, New York, NY 10016 USA
| |
Collapse
|
13
|
Maldonado LY, Songok JJ, Snelgrove JW, Ochieng CB, Chelagat S, Ikemeri JE, Okwanyi MA, Cole DC, Ruhl LJ, Christoffersen-Deb A. Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya. BMC Pregnancy Childbirth 2020; 20:288. [PMID: 32398156 PMCID: PMC7216653 DOI: 10.1186/s12884-020-02978-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors. METHODS We prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05. RESULTS Compared to controls (n = 115), a significantly higher proportion of Chamas participants (n = 211) delivered in a health facility (84.4% vs. 50.4%, p < 0.001), attended at least four ANC visits (64.0% vs. 37.4%, p < 0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p < 0·001), and received a CHV home visit within 48 h postpartum (75.8% vs. 38.3%, p < 0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12-9.64, p < 0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. CONCLUSIONS Chamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas' potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect. TRIAL REGISTRATION ClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017).
Collapse
Affiliation(s)
- Lauren Y Maldonado
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100, Kenya. .,Department of Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
| | - Julia J Songok
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100, Kenya.,Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya
| | - John W Snelgrove
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Sheilah Chelagat
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100, Kenya
| | - Justus E Ikemeri
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100, Kenya
| | | | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura J Ruhl
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100, Kenya.,Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya.,Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Astrid Christoffersen-Deb
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100, Kenya.,Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
14
|
Sripad P, Kirk K, Adoyi G, Dempsey A, Ishaku S, Warren CE. Exploring survivor perceptions of pre-eclampsia and eclampsia in Nigeria through the health belief model. BMC Pregnancy Childbirth 2019; 19:431. [PMID: 31752764 PMCID: PMC6873558 DOI: 10.1186/s12884-019-2582-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/05/2019] [Indexed: 01/05/2023] Open
Abstract
Background In Nigeria, hypertensive disorders have become the leading cause of facility-based maternal mortality. Many factors influence pregnant women’s health-seeking behaviors and perceptions around the importance of antenatal care. This qualitative study describes the care-seeking pathways of Nigerian women who suffer from pre-eclampsia and eclampsia. It identifies the influences – barriers and enablers – that affect their decision making, and proposes solutions articulated by women themselves to overcome the obstacles they face. Informing this study is the health belief model, a cognitive value-expectancy theory that provides a framework for exploring perceptions and understanding women’s narratives around pre-eclampsia and eclampsia-related care seeking. Methods This study adopted a qualitative design that enables fully capturing the narratives of women who experienced pre-eclampsia and eclampsia during their pregnancy. In-depth interviews were conducted with 42 women aged 17–48 years over five months in 2015 from Bauchi, Cross River, Ebonyi, Katsina, Kogi, Ondo and Sokoto states to ensure representation from each geo-political zone in Nigeria. These qualitative data were analyzed through coding and memo-writing, using NVivo 11 software. Results We found that many of the beliefs, attitudes, knowledge and behaviors of women are consistent across the country, with some variation between the north and south. In Nigeria, women’s perceived susceptibility and threat of health complications during pregnancy and childbirth, including pre-eclampsia and eclampsia, influence care-seeking behaviors. Moderating influences include acquisition of knowledge of causes and signs of pre-eclampsia, the quality of patient-provider antenatal care interactions, and supportive discussions and care seeking-enabling decisions with families and communities. These cues to action mitigate perceived mobility, financial, mistrust, and contextual barriers to seeking timely care and promote the benefits of maternal and newborn survival and greater confidence in and access to the health system. Conclusions The health belief model reveals intersectional effects of childbearing norms, socio-cultural beliefs and trust in the health system and elucidates opportunities to intervene and improve access to quality and respectful care throughout a woman’s pregnancy and childbirth. Across Nigerian settings, it is critical to enhance context-adapted community awareness programs and interventions to promote birth preparedness and social support.
Collapse
Affiliation(s)
- Pooja Sripad
- Population Council, 4301 Connecticut Avenue NW Suite 280, Washington, DC, 20008, USA.
| | - Karen Kirk
- Population Council, One Dag Hammarskjöld Plaza, 3rd Floor, New York, NY, 10017, USA
| | - Gloria Adoyi
- Population Council, No. 16 Mafemi Crescent, Utako District, Abuja, Nigeria
| | - Amy Dempsey
- Population Council, 4301 Connecticut Avenue NW Suite 280, Washington, DC, 20008, USA
| | - Salisu Ishaku
- Population Council, No. 16 Mafemi Crescent, Utako District, Abuja, Nigeria.,Julius Center for Health Science and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Charlotte E Warren
- Population Council, 4301 Connecticut Avenue NW Suite 280, Washington, DC, 20008, USA
| |
Collapse
|
15
|
Rosenberg M, Jules R, Luetke M, Kianersi S, Nelson E, Jean-Louis F. Health Education Training Embedded in a Microfinance Platform Associated with Safer Sexual Behavior in Haitian Women. AIDS Behav 2019; 23:2375-2385. [PMID: 30997651 DOI: 10.1007/s10461-019-02511-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sexual health education interventions have generally yielded modest impact, but may be more successful when integrated into programs designed to alleviate poverty and empower women. Between December 2017 and February 2018, we interviewed 304 Haitian female microfinance clients, 75 of whom had received health education training delivered within their regular meetings. Participants reported six key sexual health outcomes. We used log-binomial models to estimate the association between health education training and each outcome, and tested for interaction by age and literacy status. Women with health education training reported more condom use with unfaithful partners [PR (95% CI) 1.78 (1.04, 3.02)], more HIV testing [PR (95% CI) 1.56 (1.28, 1.90)], and fewer STI symptoms [PR (95% CI) 0.37 (0.19, 0.73)], compared to women with no training. Some of the associations were stronger among older women [e.g. HIV testing: PR (95% CI) 2.09 (1.49, 2.82)] and illiterate women [e.g. condom use: PR (95% CI) 3.46 (1.05, 11.38)]. These findings add to the growing body of evidence demonstrating the potential to use microfinance programs as platforms for health education delivery, and provide the first evidence for the association in Haiti.
Collapse
Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA.
| | | | - Maya Luetke
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Erik Nelson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | | |
Collapse
|
16
|
Chandrashekar S, Saha S, Varghese B, Mohan L, Shetty G, Porwal A, Hazra A, Mondal S, Das R. Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India. PLoS One 2019; 14:e0213723. [PMID: 30921334 PMCID: PMC6438566 DOI: 10.1371/journal.pone.0213723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/27/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar. Methods Cost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs. Results The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved. Conclusion SHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.
Collapse
Affiliation(s)
| | - S. Saha
- Public Health Foundation of India, New Delhi, India
- Indian Institute of Public Health, Gandhinagar, India
| | - B. Varghese
- Public Health Foundation of India, New Delhi, India
| | - L. Mohan
- Karnataka Health Promotion Trust, Bangalore, India
| | - G. Shetty
- Karnataka Health Promotion Trust, Bangalore, India
| | - A. Porwal
- Population Council, New Delhi, India
| | - A. Hazra
- Population Council, New Delhi, India
| | - S. Mondal
- Project Concern International, New Delhi, India
| | - R. Das
- Project Concern International, New Delhi, India
| |
Collapse
|
17
|
George A, Tetui M, Pariyo GW, Peterson SS. Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda. Glob Health Action 2017; 10:1359924. [PMID: 28876193 PMCID: PMC5786315 DOI: 10.1080/16549716.2017.1359924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan S Peterson
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
- Health Section, Programme Division, UNICEF NY, New York, NY, USA
- International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|