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Women’s television watching and reproductive health behavior in Bangladesh

Women's television watching and reproductive health behavior in BangladeshBangladesh has made significant social, economic, and health progress in recent decades, yet many reproductive health indicators remain weak. Access to television (TV) is increasing rapidly and provides a potential mechanism for influencing health behavior.

We present a conceptual framework for the influence of different types of TV exposure on individual’s aspirations and health behavior through the mechanisms of observational learning and ideational change. We analyze data from two large national surveys conducted in 2010 and 2011 to examine the association between women’s TV watching and five reproductive health behaviors controlling for the effects of observed confounders.

We find that TV watchers are significantly more likely to desire fewer children, are more likely to use contraceptives, and are less likely to have a birth in the two years before the survey. They are more likely to seek at least four antenatal care visits and to utilize a skilled birth attendant. Consequently, continued increase in the reach of TV and associated growth in TV viewing is potentially an important driver of health behaviors in the country.

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Gender and Participation in Option B+ Programs to Prevent Mother-to-Child Transmission of HIV in Malawi and Uganda

Gender and Participation in Option B+ Programs to Prevent Mother-to-Child Transmission of HIV in Malawi and UgandaIn Malawi and Uganda, women’s roles center on marriage and motherhood, household duties, and caring for family members and the sick. Women are supposed to consult their husbands and accept their decisions about household and health-related issues. Men’s roles are to lead and represent the family and to earn income for household expenses. These gender roles may constrain women’s access to health services, including participation in programs to prevent (Malawi) or eliminate (Uganda) mother-to-child transmission of HIV.

Countries worldwide are working to achieve the goal of having 90 percent of people diagnosed with HIV on sustained antiretroviral therapy (ART) by 2020. Maintaining 90 percent of HIV-positive women initiated on lifelong ART under the Option B+ PMTCT program has been challenging.

Other studies have documented barriers to PMTCT, but few of these were conducted under Option B+, and they did not specifically consider how gender influences PMTCT program participation. This study fills the gap, by examining the interplay of gender and individual, interpersonal, health system, and community factors related to participation in PMTCT programs.

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“If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing”: The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda

“If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing”: The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and UgandaThe role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda.

We conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organizations supporting PMTCT as well as focus group discussions with men. We analyzed the data using thematic content analysis. We found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families.

Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands’ decisions about their PMTCT participation, and some husbands are unsupportive or actively discouraging. To improve PMTCT participation, Ministries of Health should use evidence-based strategies to address HIV stigma, challenges related to disclosure, insufficient social support and male involvement, and underlying gender inequality.

This journal article was originally published in PLoS ONE 12(6): e0178298, and appears on the MEASURE Evaluation website under the terms of the Creative Commons Attribution License.

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RHINO Forum: Improving routine health data quality through the Data Quality Review Framework

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Factors that can affect the quality of health facility data are often rooted in a system issue. Consequently, addressing data quality also must be done through a system lens. Data Quality Review (DQR) provides a harmonized framework and approach to assess the quality of data reported routinely from health facilities. Led by the World Health Organization (WHO), this effort is a multi-partner effort to integrate existing data quality assurance guidelines and mechanisms under one framework. The goal of the DQR is to contribute to the improvement of the quality of data that countries use to review progress and performance, such as annual health sector reviews, programme planning, and monitoring and evaluation. The harmonized DQR framework enables countries to examine and address data quality through a holistic approach.

An upcoming RHINO forum will provide an introduction to the DQR framework and recommended metrics to measure data quality. Participants will also discuss country implementation, challenges, and the way forward. Immediately following the presentation will be a facilitated conversation, open to all participants. Questions will be shared with attendees beforehand.

The DQR forum will be moderated by a trio of experts, each of whom brings a unique perspective and expertise. Learn more and register to attend.

Barriers to and Facilitators of Sex- and Age-Disaggregated Data – Zambia

Barriers to and Facilitators of Sex- and Age-Disaggregated Data – ZambiaDecades of research demonstrate that gender inequality is associated with increased risk of HIV, maternal mortality, child stunting and wasting, poor nutrition, and other negative health outcomes. Data produced by health information systems (HIS) can be disaggregated by gender and age to advance understanding of factors associated with these health outcomes. Such data must be available for analysis and decision making to enhance health outcomes and address inequities across gender and age groups.

This report summarizes our study exploring factors that contribute to the collection and use of sex- and age-disaggregated data in Zambia and presents our recommendations for improvements.

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Gender Factors Influencing Participation in the Elimination of Mother-to-Child Transmission of HIV Program in Uganda under Option B+

Gender Factors Influencing Participation in the Elimination of Mother-to-Child Transmission of HIV Program in Uganda under Option B+In Uganda and other sub-Saharan African countries, women’s gender roles center on marriage and motherhood. According to these roles, women’s duties include caring for other members of the household, tending to household chores, and caring for the sick. Women are expected to consult with their husbands and obey their husbands’ decisions in all matters. A man’s primary role is to be the head of the family. Men are expected to bring in income to pay for shelter, food, and school, and they are expected to represent the family. Unlike women, who are expected to be faithful or monogamous, men are expected to have multiple partners (wives or girlfriends), thus signaling their masculinity. As other investigators have observed, these gender roles interfere with HIV prevention efforts. Gender roles may also constrain women’s access to health services, including those for the prevention of mother-to-child transmission of HIV (PMTCT).

Globally, all countries are working toward achieving the goal of having 90 percent of people diagnosed with HIV on sustained antiretroviral therapy (ART) by 2020. PMTCT programs in sub-Saharan Africa have had difficulty pursuing this goal, owing to countries’ weak health systems and a variety of individual, interpersonal, and cultural factors. A number of studies have examined barriers to PMTCT participation. Common constraints are fear of HIV stigma, fear of divorce or abandonment upon HIV disclosure, side effects of ART, lack of funds for transport to the clinic, negative interactions with health workers, and lack of male involvement. Most studies of barriers to PMTCT were conducted prior to the implementation of Option B+, which places HIV-positive pregnant or breastfeeding women on lifelong ART at diagnosis. By examining how gender interacts with individual, interpersonal, health system, and community factors that cause people to discontinue PMTCT, this study fills an important gap in knowledge about Option B+ programs.

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Gender Factors Influencing Participation in the Prevention of Mother-to-Child Transmission of HIV Program in Malawi under Option B+

Gender Factors Influencing Participation in the Prevention of Mother-to-Child Transmission of HIV Program in Malawi under Option B+In Malawi and other sub-Saharan African countries, women’s traditional gender roles center on marriage and motherhood, caring for family members and the sick, and household duties. Women are expected to consult with their husbands and obey their husbands’ decisions. Men’s traditional roles are to be the head of the family; bring in income to pay for shelter, food, and school fees; and represent the family. In contrast to women, who are expected to be faithful and monogamous, men are expected to have more than one wife or girlfriend, as a sign of their masculinity. These traditional gender roles have been noted as challenges to HIV prevention efforts. They may also constrain women’s access to health services, including their participation in the prevention of mother-to-child transmission (PMTCT) program.

Globally, all countries are working toward achieving the goal of having 90 percent of people who are diagnosed with HIV on sustained antiretroviral therapy (ART). This has been difficult to achieve in PMTCT programs in sub-Saharan African countries, owing to weak health care systems and a variety of individual, interpersonal, and cultural factors. A number of studies have examined barriers to PMTCT participation. Common constraints are fear of HIV stigma, fear of divorce or abandonment upon HIV disclosure, ART side effects, lack of funds for transport to the clinic, negative interactions with health workers, and lack of male involvement. Most studies of barriers were conducted prior to the implementation of Option B+, which initiates lifelong ART for HIV-positive pregnant or breastfeeding women. This study fills an important gap in knowledge about Option B+ programs, by examining how gender interplays with individual, interpersonal, health system, and community factors that contribute to the discontinuation of PMTCT participation.

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