Community Health Equity Research & Policy

In October 2001, a pilot project to design strategies to reduce HIV/AIDS transmission and improve related reproductive health practices was initiated in southern Sudan. A health facility assessment was conducted in order to determine the type and scope of care given to clients with sexually transmitted infections (STIs). It was found that many health care practitioners did not have basic training in STI diagnosis and management, and no practitioner had training in the syndromic approach. Standardized drug kits received by public facilities did not provide enough STI drugs to serve the population. Private drug stores were the only facilities where condoms were available, though condoms were not sold to women who came to purchase them without their husbands. An adequately functioning health system will be difficult to achieve without ongoing training and supervision, adequate supplies and equipment, and proper rebuilding of infrastructure and systems, such as roads, communication, and education.

Four commonly suggested public health strategies to combat childhood obesity are limiting television viewing, encouraging daily physical activity, increasing fruit and vegetable intake, and increasing water consumption. This study examined the extent to which selected social cognitive theory constructs can predict these four behaviors in upper elementary children. A 52-item valid and reliable scale was administered to 159 fifth graders. Minutes of physical activity was predicted by self-efficacy to exercise and number of times taught at school (R² = 0.072). Hours of TV watching were predicted by number of times taught about healthy eating at school and self-control through goal setting (R² = 0.055). Glasses of water consumed were predicted by expectations for drinking water (R² = 0.091). Servings of fruits and vegetables consumed were predicted by self-efficacy of eating fruits and vegetables (R² = 0.137). Social cognitive theory offers a practically useful framework for designing primary prevention interventions to reduce childhood obesity.

Diarrhea-related dehydration is a leading cause of childhood death in developing countries such as Indonesia, despite being largely preventable and treatable through use of Oral Rehydration Solution (ORS). While the extent to which ORS is used in Indonesia has been explored in earlier studies, the issue of whether it is being used correctly has not been adequately investigated. The purpose of this study was to assess mothers' ORS preparation and administration practices and to determine their source of instruction for these practices. A structured questionnaire was administered orally to 100 mothers of children under the age of 5 years, in a rural village of West Java, Indonesia. Only 23.7% of mothers were found to have correctly prepared ORS, and none exhibited fully correct administration practices. Primary sources of instruction were health workers (62.9%), package instructions (23.7%), and family members or friends (12.4%). Resulting recommendations include education of health care workers, community health education programs, reallocation of health care resources, and revision of ORS packaging guidelines.

In July 2003, a consortium of three USAID partners launched a project to promote the correct use of color-coded, age-specific, prepackaged drugs (PPDs) to treat malaria promptly in preschool-aged children in Aba, Abia State, Nigeria. A 3-pronged promotional approach included training of patent medicine vendors (PMVs), home visits by community health promoters, and mass media. Five hundred seventy respondents were interviewed in February–March 2004. People heard about the PPDs from medicine sellers (33.4%), health workers (24.3%), the electronic mass media (18.4%), and friends or relatives (13.5%). Most children (81.1%) took Robaquine (chloroquine—CQ), while 108 (18.9%) took Fansidar (sulphadoxine-pyrimethamine—SP). The median amount paid for Robaquine was x50 ($0.36) and for Fansidar, x80 ($0.57). Respondents rated the effectiveness of the PPD treatment as very effective (86.8%). Most respondents had something positive to say about the drug (94.9%) and the packaging (93.8%). Only 19.5%) had a complaint about either the drug or the packaging. Overall, 454 (83.9%) received the correct age-appropriate packet. Continuing education is needed for the PMVs to ensure that they obtain accurate age information about the child and sell the age-specific packet. Underdosing is just as serious a concern as overdosing in Nigeria where parasite resistance is rapidly developing for both drugs.

Teen mothers are at increased risk of subsequent adolescent births. Interventions to reduce secondary teen pregnancies are expensive and difficult to evaluate. An ecological evaluation compared change in the repeat teen birth rate in an intervention community in Charleston, South Carolina over time to state birth certificate data to determine the efficacy of a school-based pregnancy prevention program. Evaluation included comparison of birth rates for multigravida teens in the program's school catchment area (intervention zip codes) to selected state and community data before, during and after program implementation. The intervention community demonstrated a decrease in repeat teen births during the intervention period of the program with a rebound after it was discontinued. This trend differed from a 50% linear decrease across these time periods in the state. This low cost evaluation method may be useful for evaluation of teen pregnancy prevention programs with limited resources for program evaluation.

Of 1,200 questionnaires administered in a cross-sectional study involving University of Ibadan female students, 1000 were found useable for data analysis. Analysis found that a majority of respondents (56.4%) had little knowledge about conception and frequently engaged in sexual intercourse for many reasons, including: to have fun; to show they were mature; and to seek material reward. Also, 61.1% had procured abortion before and most of them did not procure it from government-owned hospitals/clinics, which may likely make them prone to health consequences of unsafe abortion. Part of our recommendations are the need to introduce health education (incorporating sexuality education) into the General Studies Program of the university and that home training on aspects relating to sexuality education be given to and promoted among young people.