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"Hunter, Erin"
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Blood and bone
\"A new Great Father now rules over the animals of Bravelands, but he is not what he seems, and unless the elephant Sky, the baboon Thorn, and the lion Fearless can fight his lies and unite the animals of the plains, the balance of Bravelands may be destroyed forever\"-- Provided by publisher.
Book
The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review
Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon.
We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology.
This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.
Journal Article
Shifting shadows
With the false leader destroyed, the animals of Bravelands are searching for the true Great Parent, but a mysterious new menace is threatening their lives.
Book
A systematic review of the menstrual experiences of university students and the impacts on their education: A global perspective
Higher education attainment is linked to improved health and employment outcomes but the impact of university students' experiences of menstruation on their education is less clear. The objective of this review was to synthesise qualitative and quantitative research on university students' menstrual experiences and educational impacts.
Eligible studies were identified through systematic searching across eight peer-reviewed databases, websites for menstrual health organisations, grey literature databases, and reference lists of included studies. Eligible studies must have reported on at least one of the antecedents or components of menstrual experience outlined in the integrated model of menstrual experience in relation to university students or reported on the impact of their menstrual experiences on their education. Study characteristics and findings were extracted, analysed and presented as a narrative synthesis. The quality of evidence was assessed with the Mixed Methods Appraisal Tool. This study is registered on PROSPERO, number CRD42020178470.
Eighty-three studies were eligible for inclusion. Most studies (n = 74; 89%) were quantitative and the highest proportion of studies were conducted in lower-middle-income countries (n = 31; 37%). Self-reported dysmenorrhea, other physical and emotional menstrual-related symptoms, and menstrual stigma contributed to negative menstrual experiences among female students. Very few studies considered the menstrual experiences of non-binary and transgender menstruating students, and culturally diverse students. Dysmenorrhea contributed to university absenteeism, impaired participation and concentration, and declining academic performance. Inadequate sanitation facilities for menstrual management and challenges containing menstruation also negatively impacted education.
Female university students' experiences of menstruation can negatively impact their education, highlighting the need for program and policy responses at university to improve students' wellbeing and educational engagement. Further research on the menstrual experiences of gender diverse, migrant and international students is needed as there is insufficient evidence to date.
Journal Article
Broken pride
For generations, the animals of the African plains have followed a single rule: only kill to survive. But when an unthinkable act of betrayal shatters the peace, the fragile balance between predators and prey will rest in the paws of three unlikely heroes.
Book
Development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26) in Bangladeshi schools: A measure of girls’ menstrual care confidence
Objective Qualitative studies have described girls' varying levels of confidence in managing their menstruation, with greater confidence hypothesized to positively impact health, education, and social participation outcomes. Yet, measurement of this and other psychosocial components of adolescent girls' menstrual experiences has been weak in global health research, in part due to a dearth of appropriate psychometric tools. We describe the development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26). Methods We conducted nine focus group discussions with girls in schools in rural and urban Bangladesh to identify tasks involved in menstrual self-care. This informed our creation of an initial pool of 50 items, which were reviewed by menstrual health experts and refined through 21 cognitive interviews with schoolgirls. Using a self-administered survey, we administered 34 refined items plus additional validation measures to a random sample of 381 post-menarcheal girls (ages 9-17) and retested a subsample of 42 girls two weeks later. We examined the measure's dimensionality using exploratory factor analysis and assessed internal consistency, temporal stability, and construct validity. Results Exploratory factor analysis suggested a 26-item scale comprising three correlated sub-scales: the 17-item Menstrual Hygiene Preparation and Maintenance ([alpha] = 0.86), the 5-item Menstrual Pain Management ([alpha] = 0.87), and the 4-item Executing Stigmatized Tasks ([alpha] = 0.77). Sub-scales exhibited good temporal stability. SAMNS-26 scores correlated negatively with measures of anxiety, and girls who preferred to stay at home during their periods had lower SAMNS-26 scores than those who did not. Conclusion The SAMNS-26 provides a reliable measure of a schoolgirl's confidence in her capabilities to address her menstrual needs. There is initial evidence to support the measure's construct validity in the Bangladesh context as indicated by its relationships with other factors in its theorized nomological network. The tool enables incorporation of self-efficacy into multivariate models for exploring the relationships among antecedents to menstrual experiences and hypothesized impacts on health, wellbeing, and education attainment. Further testing of the tool is recommended to strengthen evidence of its validity in additional contexts.
Journal Article
The Endless Lake
\"Lucky and his Pack must learn to survive in their new home, at the edge of a strange lake that seems to go on forever\"-- Provided by publisher.
Book
Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis
High-quality obstetric delivery in a health facility reduces maternal and perinatal morbidity and mortality. This systematic review synthesizes qualitative evidence related to the facilitators and barriers to delivering at health facilities in low- and middle-income countries. We aim to provide a useful framework for better understanding how various factors influence the decision-making process and the ultimate location of delivery at a facility or elsewhere. We conducted a qualitative evidence synthesis using a thematic analysis. Searches were conducted in PubMed, CINAHL and gray literature databases. Study quality was evaluated using the CASP checklist. The confidence in the findings was assessed using the CERQual method. Thirty-four studies from 17 countries were included. Findings were organized under four broad themes: (1) perceptions of pregnancy and childbirth; (2) influence of sociocultural context and care experiences; (3) resource availability and access; (4) perceptions of quality of care. Key barriers to facility-based delivery include traditional and familial influences, distance to the facility, cost of delivery, and low perceived quality of care and fear of discrimination during facility-based delivery. The emphasis placed on increasing facility-based deliveries by public health entities has led women and their families to believe that childbirth has become medicalized and dehumanized. When faced with the prospect of facility birth, women in low- and middle-income countries may fear various undesirable procedures, and may prefer to deliver at home with a traditional birth attendant. Given the abundant reports of disrespectful and abusive obstetric care highlighted by this synthesis, future research should focus on achieving respectful, non-abusive, and high-quality obstetric care for all women. Funding for this project was provided by The United States Agency for International Development (USAID) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization.
Journal Article
Warriors
Describes the adventures of Graystripe, a former leader of ThunderClan, as he struggles between staying with his adopted Twoleg family and embarking on a quest to find his lost feline companions.
Book
Impact of a school-based water and hygiene intervention on child health and school attendance in Addis Ababa, Ethiopia: a cluster-randomised controlled trial
Background
School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance.
Methods
The WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2–4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7–16) in an ‘open cohort’. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March–June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat.
Results
Of 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94–112), 5987 enrolled at study initiation (23rd November–22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71–1.00;
p
= 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84–1.59;
p
= 0.39) nor roll-call absence (aOR 1.07; 95% 0.83–1.38;
p
= 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0–100 scale; 95% CI 0.05–6.59), and no evidence of effects on other secondary outcomes.
Conclusions
This large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes.
Trial registration
ClinicalTrials.gov, number NCT05024890.
Journal Article