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The Importance of Gender in Tuberculosis Data

gender-tbAddressing gender when monitoring and evaluating tuberculosis (TB) projects helps ensure equity in access and benefits for men and women. This brief establishes the importance of gender in monitoring and evaluation activities and suggests indicators to reveal and explain gender gaps in TB outcomes.

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PLACE Swaziland Adolescent Girls and Young Women, Their Partners, and Men Ages 20–34

tr-17-168Adolescent girls and young women (AGYW) account for a larger proportion of new HIV infections among their age group compared to their male peers. In order to curb the HIV epidemic in countries with generalized epidemics, it is important to understand the risk behaviors of AGYW and their male partners. This study was designed to identify risk behaviors of AGYW and young men ages 20 to 34 in Swaziland to get a general understanding of the characteristics of male partners of AGYW. These data will be used in activities as part of the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) Initiative of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) to focus HIV testing services and linkage to care or other high-impact interventions more precisely on male partners.

Specifically, the study was designed to characterize male sexual partners of AGYW, describe sexual partnerships among AGYW and their partners, profile health-seeking behaviors of male partners, and identify spots where AGYW and young men socialize and meet new sexual partners in the 19 tinkhundla identified as priorities by DREAMS. (A tinkhundla is a geographic administrative area smaller than a region.)

The study was a modification of the Priorities for Local AIDS Control Efforts (PLACE) method, a time–location-based sampling strategy developed by MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID) and PEPFAR. The study had three main components. The first was a community informant step in which interviewers asked knowledgeable members of the community where AGYW meet new sexual partners. The second was verification of this list of identified spots. The third was interviews with patrons and workers at those verified spots about their knowledge, attitudes, and behaviors.

The interview team verified 777 spots—drinking spots, kiosks and shops, and bars and clubs, among others—where AGYW meet new sexual partners in the 19 DREAMS tinkhundla. HIV prevention outreach and education at those spots are limited, but informants at more than half of the spots reported that they would be open to further interventions. The most common type of HIV prevention was the availability of free condoms at 45 percent of the spots in the past six months.

Interviews were conducted with 1,641 patrons and workers at 182 of the 777 spots where people meet new sexual partners. Of the 843 young men ages 20 to 34 who were interviewed, 553 said they had had an AGYW sexual partner in the past year. Characteristics of male partners varied by age group: younger male partners were more often single, dependent on family, in school, and unemployed than older male partners.

Male partners more often reported engaging in risky behaviors compared to their female peers. They consumed alcohol more frequently and in greater amounts. Nearly one-third had used marijuana in the past year, 13 percent had been imprisoned or in jail, and 15 percent had slept outside due to homelessness. Male partners had an average of 3.2 sexual partners in the past year, with 31 percent having had three to nine partners. They met these partners on the street, at bars or clubs, at taxi or bus ranks, or at school, among other places. Five percent had paid for sex in the past year. Thirty-seven percent of male partners said they had always used condoms in the past year.

Not all AGYW are engaged in high-risk behavior. Only 26 percent reported ever having had sex, although social desirability bias may affect this figure. The majority of AGYW reported having had only one partner in the past year. But among those who did have a partner, close to half believed their partner had other sexual partners. Additionally, 13 percent of adolescent girls who were sexually active had received money in exchange for sex.

In general, male partners of AGYW had partners who were zero to four years younger. Among adolescent girls, 98 percent said their last male partner was between zero and nine years older, with 20 percent saying their partner was five to nine years older. This percentage was 38 for young women.

Most respondents knew where to get an HIV test; however, fewer had been tested at least once in their lifetimes. Self-reported HIV rates were low in comparison with surveillance data. The highest reported rate was among male partners ages 30 to 34, at 8.9 percent. The lowest was among male partners ages 20 to 24, at 2.4 percent. Thirty-seven percent of male partners were circumcised, suggesting that there is room for further intervention.

All respondents frequently visited the spot where they were interviewed. Mobile testing appeared to be popular among male partners, perhaps offering a greater opportunity to reach people at places they visit frequently. It is prudent for this type of information be used to identify high-impact interventions that can reach high-risk groups both to prevent the spread of HIV and to link those who are HIV-positive to care.

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Assessing Training Approaches and a Supportive Intervention for Managing Febrile Illness in Tanzania – Tibu Homa Performance Evaluation Report

tr-17-1Integrated management of childhood illnesses (IMCI) is an approach to case management that includes a detailed algorithm for how to assess a child, classify the child’s illness, determine if referral is necessary, treat the child, counsel the mother, and provide follow-up care (World Health Organization [WHO], 2014). Developed by WHO and the United Nations Children’s Fund (UNICEF), IMCI was introduced in Tanzania in 1996. While under-five (U5) mortality in Tanzania has declined over the past two decades, socioeconomic disparities in child mortality persist and are especially prominent in rural areas. The Lake Zone of Tanzania, which surrounds Lake Victoria, has the highest U5 mortality rate in the country. The chief causes of postneonatal deaths in children 1–59 months in Tanzania are estimated to be pneumonia (22%) and malaria (16%) (Liu, et al., 2015). Because severe febrile illness is a key symptom both of malaria and pneumonia, accurate diagnosis and treatment of severe febrile illness is critical to efforts to reduce U5 mortality.

To reduce U5 morbidity and mortality owing to diseases that cause severe febrile illness, the United States Agency for International Development (USAID) Tanzania established the Tibu Homa project (Swahili for “Treat Fever”) in the Lake Zone through a cooperative agreement with University Research Co., LLC. The goals of the project were these: (1) increase availability and accessibility of fundamental facility-based curative and preventive child health services; (2) ensure sustainability of critical child health activities; and (3) increase linkages with the community to promote healthy behaviors and increase knowledge and use of child health services. Tibu Homa was implemented from March 2011–September 2015.

Tibu Homa worked with health facilities to train healthcare workers (HCWs) in IMCI. During Phase 1 of Tibu Homa (2011–2012), HCWs were trained on IMCI through an abbreviated three-day, in-person training focused on febrile illness. This was a modified version of the standard 11-day in-person IMCI training. Beginning in 2013 (Phase 2 of Tibu Homa), distance integrated management of childhood illnesses (dIMCI) replaced the in-person training as required by guidelines at that time of Tanzania’s Ministry of Health and Social Welfare (MOHSW)— now the Ministry of Community Development, Gender, Elderly, and Children (MoHCDGE&C]).

USAID/Tanzania asked the USAID-funded MEASURE Evaluation to conduct a performance evaluation of the association between (1) the training modalities and (2) supportive components implemented by Tibu Homa, with quality of care (QOC). The results are intended to inform the selection of future supportive interventions that may be implemented by USAID/Tanzania or the government of Tanzania (GOT) in conjunction with dIMCI training to enhance HCW compliance with the IMCI algorithm. The broad objectives of the evaluation were to estimate the added value of Tibu Homa’s supportive components.

The evaluation uses a retrospective, mixed-methods approach. Data sources are a cross-sectional quantitative health facility survey, qualitative and costing data collection, secondary time series data, and project document review. Primary outcomes are measures of QOC, which are defined by the WHO Health Facility Survey (HFS) and include the Index of Integrated Assessment (called the “IMCI score”); correct classification; and correct treatment of cases observed or reviewed in patient records.

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The Importance of Gender in HIV and AIDS Data

gender-hivAddressing gender when monitoring and evaluating HIV projects ensures equity in access and benefits for men and women. This brief establishes the importance of addressing gender in monitoring and evaluation activities and suggests indicators to reveal and explain gender gaps in HIV and AIDS outcomes.

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Using DHIS 2 to Strengthen Health Systems

dhis-2DHIS 2 is a software platform that the University of Oslo developed in 2006 to manage health information systems (HIS). The first implementation was in India in 2006 and the first national rollout was in Kenya in 2010. Since then, low- and middle-income countries (LMICs) worldwide have adopted the software. DHIS 2 is flexible, adaptable, and extendable through web application program interfaces (APIs), which are useful for building software applications (apps). It can be customized to suit many purposes for health information management and for nonhealth sectors, too.

An optimally functioning DHIS 2 can host a myriad of health data from many sources and can be used to produce information products that facilitate data use. Deployed within a supportive and organized health information system (HIS), it can result in improved health for people. It is a powerful tool, but its effectiveness depends on many factors indicative of strong HIS: leadership and good management, governance of policies and procedures, and the skills of the people who work with the DHIS 2 tool. That is where MEASURE Evaluation plays its important role in the DHIS 2 landscape.

For more than 20 years, the United States Agency for International Development (USAID) has funded MEASURE Evaluation to help strengthen HIS around the world and to measure, evaluate, and share globally strategies that strengthen HIS in LMICs. To that end, the project has been instrumental in helping these countries establish or strengthen their HIS, many of which use DHIS 2.

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Household Microbial Water Quality Testing in a Peruvian Demographic and Health Survey: Evaluation of the Compartment Bag Test for Escherichia coli

ajtmhThe Joint Monitoring Program relies on household surveys to classify access to improved water sources instead of measuring microbiological quality. The aim of this research was to pilot a novel test for  quantification of household drinking water in the 2011 Demographic and Health Survey (DHS) in Peru. In the Compartment Bag Test (CBT), a 100-mL water sample is supplemented with chromogenic medium to support the growth of , poured into a bag with compartments, and incubated. A color change indicates  growth, and the concentration of /100 mL is estimated as a most probable number. Triplicate water samples from 704 households were collected; one sample was analyzed in the field using the CBT, another replicate sample using the CBT was analyzed by reference laboratories, and one sample using membrane filtration (MF) was analyzed by reference laboratories. There were no statistically significant differences in  concentrations between the field and laboratory CBT results, or when compared with MF results. These results suggest that the CBT for  is an effective method to quantify fecal bacteria in household drinking water. The CBT can be incorporated into DHS and other national household surveys as a direct measure of drinking water safety based on microbial quality to better document access to safe drinking water.

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The Importance of Gender in Data on Orphans and Vulnerable Children

gender-ovcAddressing gender when monitoring and evaluating projects for orphans and vulnerable children (OVC) helps ensure equity in access and benefits for boys and girls. This brief explores the importance of gender in monitoring and evaluation activities and suggests indicators to reveal and explain gender gaps in OVC outcomes.

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