Explore the vast range of titles available.

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.

Conversations regarding qualitative research and qualitative data analysis in global public health programming often emphasize the product of data collection (audio recordings, transcripts, codebooks and codes), while paying relatively less attention to the process of data collection. In qualitative research, however, the data collector’s skills determine the quality of the data, so understanding data collectors’ strengths and weaknesses as data are being collected allows researchers to enhance both the ability of data collectors and the utility of the data. This paper defines and discusses a process for systematic debriefings. Debriefings entail thorough, goal-oriented discussion of data immediately after it is collected. Debriefings take different forms and fulfill slightly different purposes as data collection progresses. Drawing from examples in our health systems research in Tanzania and Sierra Leone, we elucidate how debriefings have allowed us to: enhance the skills of data collectors; gain immediate insights into the content of data; correct course amid unforeseen changes and challenges in the local context; strengthen the quality and trustworthiness of data in real time; and quickly share emerging data with stakeholders in programmatic, policy and academic spheres. We hope this article provides guidance and stimulates discussion on approaches to qualitative data collection and mechanisms to further outline and refine debriefings in qualitative research.

Group antenatal care (G-ANC) is a promising model for improving quality of maternal care and outcomes in low- and middle-income countries (LMICs) but little has been published examining the mechanisms by which it may contribute to those improvements. Substantial interplay can be expected between pregnant women and providers' respective experiences of care, but most studies report findings separately. This study explores the experience and effects of G-ANC on both women and providers to inform an integrated theory of change for G-ANC in LMICs. This paper reports on multiple secondary outcomes from a pragmatic cluster randomized controlled trial of group antenatal care in Kenya and Nigeria conducted from October 2016-November 2018 including 20 clusters per country. We collected qualitative data from providers and women providing or receiving group antenatal care via focus group discussions (19 with women; 4 with providers) and semi-structured interviews (42 with women; 4 with providers). Quantitative data were collected via surveys administered to 1) providers in the intervention arm at enrollment and after facilitating 4 cohorts and 2) women in both study arms at enrollment; 3-6 weeks postpartum; and 1 year postpartum. Through an iterative approach with framework analysis, we explored the interactions of voiced experience and perceived effects of care and placed them relationally within a theory of change. Selected variables from baseline and final surveys were analyzed to examine applicability of the theory to all study participants. Findings support seven inter-related themes. Three themes relate to the shared experience of care of women and providers: forming supportive relationships and open communication; becoming empowered partners in learning and care; and providing and receiving meaningful clinical services and information. Four themes relate to effects of that experience, which are not universally shared: self-reinforcing cycles of more and better care; linked improvements in health knowledge, confidence, and healthy behaviors; improved communication, support, and care beyond G-ANC meetings; and motivation to continue providing G-ANC. Together these themes map to a theory of change which centers the shared experience of care for women and providers among multiple pathways to improved outcomes. The reported experience and effects of G-ANC on women and providers are consistent with other studies in LMICs. This study is novel because it uses the themes to present a theory of change for G-ANC in low-resource settings. It is useful for G-ANC implementation to inform model development, test adaptations, and continue exploring mechanisms of action in future research.

In settings of mass displacement, unaccompanied minors (UAMs) are recognized as a vulnerable group and consequently prioritized by relief efforts. This study examines how the interpretation of vulnerability by the national shelter system for male UAMs in Greece shapes their trajectories into adulthood. Between August 2018 and April 2019, key informant interviews were carried out with child protection staff from Greek non-governmental organizations that refer UAMs to specialized children's shelters in Athens to understand how child protection workers interpret vulnerability. In-depth interviews and life history calendars were collected from 44 male migrant youths from Afghanistan, Pakistan, Bangladesh, and Iran who arrived in Greece as UAMs but had since transitioned into adulthood. Analysis of in-depth interviews and life history calendars examined how cumulative disadvantage and engagement with the shelter system altered youths' trajectories into adulthood. Younger adolescents were perceived as more vulnerable and prioritized for shelters over those who were \"almost 18\" years old. However, a subset of youths who requested shelter at the age of 17 years had experienced prolonged journeys where they spent months or years living on their own in socially isolated environments that excluded them from experiences conducive to adolescent development. The shelter system for UAMs in Greece enabled youths to develop new skills and networks that facilitated integration into society, and transferred them into adult housing when they turned 18 years old so that they could continue developing new skills. Those who were not in shelters by age 18 years could not access adult housing and lost this opportunity. Limitations included possible underrepresentation of homeless youth as well as the inability to capture all nationalities of UAMs in Greece, though the 2 most common nationalities, Afghan and Pakistani, were included. Due to the way vulnerability was interpreted by the shelter system for UAMs, youths who had the greatest need to learn new skills to facilitate their integration often had the least opportunity to do so. To avoid creating long-lasting disparities between UAMs who are placed in shelters and those who are not, pathways should be developed to allow young adult males to enter accommodation facilities and build skills and networks that facilitate integration. Furthermore, cumulative disadvantages should be taken into account while assessing UAMs' vulnerability. Following UAMs' trajectories into early adulthood was critical for capturing this long-term consequence of the shelter system's interpretation of vulnerability.

Peter Guy Winch (1926–1997) was one of the most important philosophers of the second half of the twentieth century. He is best known for his early work on the philosophy of the social sciences, in particular his monograph The Idea of a Social Science and its Relation to Philosophy (1958), which generated controversy within both philosophical and social scientific circles. This volume unites Peter Winch’s previously unpublished work on Baruch de Spinoza. The primary source for the text is a series of seminars on Spinoza that Winch gave, first at the University of Swansea in 1982 and then at King’s College London in 1989. Audio recordings of the majority of the Swansea seminars have survived. The editors have transcribed these, edited them for coherence, style and clarity, and supplemented them with material drawn from Winch’s typescripts and preparatory notebooks. What emerges is an original interpretation of Spinoza’s work that demonstrates his continued relevance to contemporary issues in metaphysics, epistemology and ethics, and establishes connections to other philosophers - not only Spinoza’s predecessors such as Descartes, but also to the philosophical views of Ludwig Wittgenstein and Simone Weil. There is currently a resurgence of interest in Spinoza’s philosophy, and this volume will contribute to burgeoning debates within that field. Winch’s account of Spinoza is uncommon insofar as it takes as central to Spinoza’s project his conceptions of meaning, understanding and language, and directly connecting these to his ethical concerns. At the same time, Winch makes useful links to modern debates in ways that throw helpful light on Spinoza. As well as issues which are central to the philosophy of language, these include debates on the nature of the mind, naturalism and the place of the human being within the natural world.

Background Promotion and provision of low-cost technologies that enable improved water, sanitation, and hygiene (WASH) practices are seen as viable solutions for reducing high rates of morbidity and mortality due to enteric illnesses in low-income countries. A number of theoretical models, explanatory frameworks, and decision-making models have emerged which attempt to guide behaviour change interventions related to WASH. The design and evaluation of such interventions would benefit from a synthesis of this body of theory informing WASH behaviour change and maintenance. Methods We completed a systematic review of existing models and frameworks through a search of related articles available in PubMed and in the grey literature. Information on the organization of behavioural determinants was extracted from the references that fulfilled the selection criteria and synthesized. Results from this synthesis were combined with other relevant literature, and from feedback through concurrent formative and pilot research conducted in the context of two cluster-randomized trials on the efficacy of WASH behaviour change interventions to inform the development of a framework to guide the development and evaluation of WASH interventions: the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH). Results We identified 15 WASH-specific theoretical models, behaviour change frameworks, or programmatic models, of which 9 addressed our review questions. Existing models under-represented the potential role of technology in influencing behavioural outcomes, focused on individual-level behavioural determinants, and had largely ignored the role of the physical and natural environment. IBM-WASH attempts to correct this by acknowledging three dimensions (Contextual Factors, Psychosocial Factors, and Technology Factors) that operate on five-levels (structural, community, household, individual, and habitual). Conclusions A number of WASH-specific models and frameworks exist, yet with some limitations. The IBM-WASH model aims to provide both a conceptual and practical tool for improving our understanding and evaluation of the multi-level multi-dimensional factors that influence water, sanitation, and hygiene practices in infrastructure-constrained settings. We outline future applications of our proposed model as well as future research priorities needed to advance our understanding of the sustained adoption of water, sanitation, and hygiene technologies and practices.

Background In malaria endemic regions, intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended for all pregnant women during prenatal consultation, from the fourth month of pregnancy up to the time of delivery. The Government of Mali is aiming for universal coverage of IPTp-SP. However, coverage is still low, estimated to be 18% for completion of three doses (IPTp-SP3). The objective of this study was to identify the factors that influence IPTp-SP adherence in the Health District of Sélingué, Mali. Methods This was a cross-sectional survey with 30 clusters, proportional to village size, with two stages of sampling. Data were collected electronically with Magpi software during face-to-face interviews/surveys. The data were analysed with SPSS version 20. A descriptive analysis and bivariate and multivariate logistic regression were performed. An equity analysis examined the effect of distance from health care facility on completion of three or more antenatal visits (ANC3 +) and three or more doses of intermittent preventive treatment (IPTp-SP3 +). Results Of the 1,021 women surveyed, 87.8% (n = 896) attended at least one ANC visit. Of these, 86.3% (n = 773) received at least one dose of IPTp-SP. Compliance with three or more doses of IPTp-SP was 63.7%. The determinants statistically related to ANC3 + were the early initiation of ANC (OR = 3.22 [1.22, 10.78]), and the presence of a community health centre (CHC) in the village (OR = 9.69 [1.09, 86.21]). The ability to read (OR = 1.60 [1.01, 2.55]), the early initiation of ANC (OR = 1.46 [1.06, 2.00], knowledge of the utility of the drug (OR = 2.38 [1.24, 4.57]), and knowledge of the recommended dose of the drug (OR = 6.11 [3.98, 9.39]) were related to completion of three or more treatments (IPTp-SP3 +). Conclusion The early initiation of ANC was a positive determinant of the completeness of both ANC3 + and IPTp-SP3 + . This study shows that a successful implementation of the IPTp strategy can be achieved by improving access to prenatal care at community health facilities, and strengthening patient-provider communication to ensure adequate knowledge on dosing of IPTp-SP and the benefits to mother and child.

A previous cluster-randomized controlled trial in Bangladesh found that individual or combined water, handwashing, sanitation, and nutrition interventions during pregnancy and after birth improved developmental outcomes of children at 1 and 2 years of age. In this study, we aimed to determine if these intervention effects were sustained for children at school age. Clusters of pregnant women were enrolled between May 31, 2012 and July 7, 2013 and block-randomized into chlorinated drinking water (W); improved sanitation (S); handwashing with soap (H); combined WSH; nutrition counseling and provision of lipid-based supplements (N); combined WSH + N, or a double-sized passive control arm (C) with no intervention visits (N = 5,551). The primary outcomes of the main trial after the 2-year intervention were 7-day diarrhea prevalence and length-for-age z-score, measured in 4,584 children of enrolled pregnant women. We conducted a post hoc, follow-up of all initially enrolled mothers and their children 5 years after intervention completion, when children were 7 years old. Primary outcomes were child cognition assessed using the Wechsler Pre and Primary Scale of Intelligence (WPPSI-IV), along with assessments of fine motor abilities, behavior, school achievement, and executive function; secondary outcomes were maternal mental health and stimulation in the home environment. We conducted intention-to-treat analyses using generalized linear models to calculate unadjusted and adjusted comparisons between each arm and the control group, accounting for block-level clustering. Between September 2019 and February 2021, we re-enrolled 4,175 households from all 720 original clusters, with the full set of child development assessments conducted on 3,833 children across 718 clusters. Children in the WSH + N, N, and S arms had improved cognitive scores on one or more domains compared to the control arm, with adjusted effect sizes between 0.10 (95%CI: 0.00, 0.20) and 0.15 (0.03, 0.27). Children in the W, H, N, WSH, and WSH + N arms demonstrated improved prosocial behaviors (adjusted effect sizes between 0.20 (0.07, 0.33) and 0.31 (0.16, 0.46)) and reduced difficult behaviors (adjusted effect sizes between -0.15 (-0.28, -0.01) and -0.31 (-0.45, -0.17)). No intervention effects were observed for fine motor, executive functioning, or school achievement outcomes. Maternal depressive symptoms were improved in the WSH + N, H, and N arms (adjusted effect sizes between -0.14 (-0.24, -0.03) and -0.21 (-0.31, -0.11)), and the stimulating home environment was improved in all intervention arms (adjusted effect sizes between 0.17 (0.01, 0.33) and 0.40 (0.25, 0.56)). Children whose families had higher wealth at baseline and those who were male tended to have larger effect sizes on the FSIQ. Data collection for this study was interrupted by a 6-month pause at the start of the COVID-19 pandemic. The main limitation of this study is loss to follow-up. At 7 years of age, we found small, sustained benefits of early water, sanitation, handwashing, and nutrition interventions on child cognitive and socioemotional outcomes, the stimulating home environment, and maternal mental health. Future work to determine the mechanisms underlying these intervention effects will further inform the design of early interventions to improve child health and development. Trial registration: Follow-up trial: ClinicalTrials.gov, NCT04443855. Original WASH-Benefits Bangladesh (WASH-B): ClinicalTrials.gov, NCT01590095.

The ‘continuum of care’ is proposed as a key framework for the delivery of maternal, neonatal and child health services. This study examined the extent of dropout as well as factors associated with retention across the MNCH continuum from antenatal care (ANC), through skilled birth attendance (SBA), to postnatal care (PNC). We analyzed data from 1931 women who delivered in the preceding 2–14 months, from a twostage cluster sampling household survey in four districts of Tanzania’s Morogoro region. The survey was conducted in 2011 as a part of a baseline for an independent evaluation of a maternal health program. Using the Anderson model of health care seeking, we fitted logistic models for three transition stages in the continuum. Only 10% of women received the ‘recommended’care package (4+ANC visits, SBA, and 1+PNC visit), while 1% reported not having care at any stage. Receipt of four ANC visits was positively associated with women being older in age (age 20–34 years—OR: 1.77, 95% CI: 1.22–2.56; age 35–49 years—2.03, 1.29–3.2), and knowledge of danger signs (1.75, 1.39–2.1). A pro-rich bias was observed in facility-based deliveries (proxy for SBA), with women from the fourth (1.66, 1.12–2.47) and highest quintiles of household wealth (3.4, 2.04–5.66) and the top tertile of communities by wealth (2.9, 1.14–7.4). Higher rates of facility deliveries were also reported with antenatal complications (1.37, 1.05–1.79), and 4+ANC visits (1.55, 1.14–2.09). Returning for PNC was highest among the wealthiest communities (2.25, 1.21–4.44); catchment areas of a new PNC program (1.89, 1.03–3.45); knowledge of danger signs (1.78, 1.13–2.83); community health worker counselling (4.22, 1.97–9.05); complicated delivery (3.25, 1.84–5.73); and previous health provider counselling on family planning (2.39, 1.71–3.35). Dropout from maternal care continuum is high, especially for the poorest, in rural Tanzania. Interactions with formal health system and perceived need for future services appear to be important factors for retention. ”连续照护”是孕产妇、新生儿和儿童健康服务提供的关键框 架。MNCH 连续照护是从产前护理 （ANC） 、熟练助产护 理 （SBA） 到产后护理（PNC） 的连续过程, 本研究调查中途 退出 MNCH连续照护和继续使用的相关因素。 我们在坦桑尼亚莫罗戈罗省的四个区采用二阶段整群抽样住 户调查, 收集并分析了过去2-14个月分娩的 1931 位妇女的数 据并分析。该调查于 2011 年进行, 是一项孕产妇健康项目独 立评估基线调查的一部分。采用安德森模型分析求医行为, 建 立 Logistic 模型分析连续照护中的三个过渡阶段。 仅10%的妇女接受了推荐的整体护理 （4+ANC, SBA和1+PNC）, 1%的妇女未在任何阶段使用 MUCH 护理。接受四次 ANC 检查与年龄呈正相关（20–34 岁： OR=1.77, 95%CI 1.22–2.56； 35–49 岁： OR=2.03, 95%CI 1.29–3.2）, 与对危 险体征的了解也呈正相关 （1.75, 1.39–2.1） 。院内分娩 （SBA 的代理变量） 显示偏向富人的偏倚, 最富裕五分之一 和其次家庭的妇女院内分娩较高 （3.4, 2.04–5.66； 1.66, 1.12–2.47）, 最富裕的三分之一社区的妇女院内分娩也较高 （2.9, 1.14–7.4） 。 高院内分娩率还与产前并发症 （1.37, 1.05–1.79） 和接受4þ ANC 检查相关（1.55, 1.14–2.09） 。 与 返回医疗机构接受PNC 关联最强的是最富裕社区 （2.25, 1.21–4.44） ；新 PNC 项目服务地区 （1.89, 1.03–3.45） ； 了 解危险体征 （1.78, 1.13–2.83） ； 有社区卫生工作者咨询服务 （4.22, 1.97–9.05） ； 并发症分娩 （3.25, 1.84–5.73）； 和既 往计划生育咨询 （2.39, 1.71–3.35） 。 中途退出连续孕产妇保健的比例较高, 尤其是在坦桑尼亚贫困 人口和农村地区。与卫生体系的接触和对未来医疗服务需求 的预估可能是继续使用孕产妇保健的重要因素。 El ‘continuo de la atención’ se propone como un marco clave para la prestación de servicios de salud materna, neonatal e infantil (SMNI). Este estudio examinó el grado de deserción, así como los factores asociados con la retención a través del continuo de SMNI desde el cuidado prenatal (CPN), a través de la asistencia especializada en el parto (AEP), a la atención postnatal (APN). Analizamos los datos de 1931 mujeres que dieron a luz entre los 2 y 14 meses anteriores, de una encuesta de hogares de muestreo por grupos de dos etapas en cuatro distritos de la región de Morogoro en Tanzania. La encuesta se llevó a cabo en 2011 como parte de una línea de base para una evaluación independiente de un programa de salud materna. Usando el modelo de Anderson de la búsqueda de atención de salud, ajustamos los modelos logísticos para tres etapas de transición en el continuo. Sólo el 10% de las mujeres recibieron el paquete de atención “recomendado” (4+ visitas de CPN, AEP y 1 visita APN), mientras que el 1% informó que no había recibido atención en ninguna etapa. Haber recibido cuatro visitas de CPN se asoció positivamente con mujeres mayores en edad (edad 20-34 años—RP: 1.77, IC 95%: 1.22-2.56, edad 35 a 49 años—2.03, 1.29-3.2) y conocimiento de las señales de peligro (1.75, 1.39 – 2.1). Se observó un sesgo favorable a los ricos en los partos basados en instalaciones (lo cual representa la AEP), con las mujeres del cuarto quintil (1.66, 1.12-2.47) y el quintil más altos de la riqueza de los hogares (3.4, 2.04-5.66) y el tercio superior de las comunidades por riqueza (2.9, 1.14-7.4). También se reportaron tasas más altas de partos en instalaciones con complicaciones prenatales (1.37, 1.05-1.79), y 4+ visitas de CPN (1.55, 1.14- 2.09). El regreso a la APN fue mayor entre las comunidades más ricas (2.25, 1.21-4.44); áreas de captación de un nuevo programa de APN (1.89, 1.03-3.45); conocimiento de señales de peligro (1.78, 1.13-2.83); asesoramiento de trabajadores comunitarios de salud (4.22, 1.97-9.05); parto complicado (3.25, 1.84 – 5.73); y asesoramiento previo de proveedores de salud sobre planeación familiar (2.39, 1.71-3.35). La deserción del continuo de la atención materna es alta, especialmente para los más pobres, en las zonas rurales de Tanzania. Las interacciones con el sistema formal de la salud y la necesidad percibida de servicios futuros parecen ser factores importantes para la retención.

Girls’ menstrual experiences impact their social and educational participation, physical and psychological health. We conducted a pilot study to assess the acceptability and feasibility of a multi-component intervention intended to support menstruating girls; improve menstrual care knowledge, practices, and comfort; and increase school attendance. We conducted a pre/post evaluation of a 6-month pilot intervention in four schools (2 urban, 2 rural) in Dhaka, Bangladesh. We selected 527 schoolgirls (grades 5 to 10; aged 10 to 17 years) for a baseline survey and 528 girls at endline. The intervention included: 1) Menstrual Hygiene Management (MHM) packs– reusable cloth pads, underwear, carry bags and menstrual cycle tracking calendars, 2) education curriculum- pictorial flipcharts, puberty related-booklets, and teachers’ training to deliver puberty and MHM sessions, 3) maintenance- improvements to school sanitation, provision of disposable pads in the school office, provision of chute disposal systems for disposable pads, and gender committees to promote a gender-friendly school environment and maintenance of intervention facilities. We estimated intervention uptake and intervention effect by calculating prevalence differences and 95% confidence intervals using fixed-effects logistic regression. The intervention uptake was more than 85% for most indicators; 100% reported receiving puberty education, 85% received MHM packs, and 92% received booklets. Reusable cloth pads uptake was 34% by endline compared with 0% at baseline. Knowledge about menstrual physiology and knowledge of recommended menstrual management practices significantly improved from baseline to endline. Reported improvements included more frequent changing of menstrual materials (4.2 times/day at endline vs. 3.4 times/day at baseline), increased use of recommended disposal methods (prevalence difference (PD): 8%; 95% Confidence Interval: 1, 14), and fewer staining incidents (PD: − 12%; 95% CI: − 22, − 1). More girls reported being satisfied with their menstrual materials (59% at endline vs. 46% at baseline, p  < 0.005) and thought school facilities were adequate for menstrual management at endline compared to baseline (54% vs. 8%, p  < 0.001). At endline, 64% girls disagreed/strongly disagreed that they felt anxious at school due to menstruation, compared to 33% at baseline ( p  < 0.001). Sixty-five percent girls disagreed/strongly disagreed about feeling distracted or trouble concentrating in class at endline, compared to 41% at baseline ( p  < 0.001). Self-reported absences decreased slightly (PD: − 8%; 95% CI: − 14, − 2). Uptake of cloth pads, improved maintenance and disposal of menstrual materials, and reduced anxiety at school suggest acceptability and feasibility of the intervention aiming to create a supportive school environment.