Georges Danhoundo

Trends and determinants of HIV/AIDS knowledge among women in Bangladesh

BackgroundGlobally, women share an indiscriminate burden of the HIV epidemic and the associated socioeconomic consequences. Previous studies have demonstrated a positive correlation between levels of HIV knowledge with its prevalence. However, for Bangladesh such evidence is non-existent. In this study, we aimed to explore the extent of HIV knowledge in relation to the socio-demographic variables such as age, region, area of residence i.e., urban or rural, wealth index and education, and investigate the factors influencing the level of HIV knowledge among Bangladeshi women.MethodsWe used data from the Bangladesh Demographic and Health Survey (BDHS) survey conducted in 2011. In total 12,512 women ageing between 15 and 49 ever hearing about HIV regardless of HIV status were selected for this study. HIV knowledge level was estimated by analyzing respondents’ answers to a set of 11 basic questions indicative of general awareness and mode of transmission. Descriptive statistics, cross-tabulation and multinominal logistic regression were performed for data analysis.ResultsLittle over half the respondents had good knowledge regarding HIV transmission risks. The mean HIV knowledge score was −0.001 (SD 0.914). Average correct response rate about mode of transmission was higher than for general awareness. Educational level of women and sex of household head were found to be significantly associated with HIV knowledge in the high score group. Those with no education, primary education or secondary education were less likely to be in the high score group for HIV knowledge when compared with those with higher than secondary level of education. Similarly those with male as household head were less likely to be in the higher score group for HIV knowledge.ConclusionsLevel of HIV knowledge among Bangladeshi women is quite low, and the limiting factors are rooted in various demographic and household characteristics. Education and sex of the household head have been found to be significantly correlated with the level of HIV knowledge and propound sound grounds for their incorporation in the future HIV prevention strategies. Education of women may also have wider ramifications allowing reduction in gender inequality, which in turn favors higher knowledge about HIV.

Extent of Knowledge about HIV and Its Determinants among Men in Bangladesh.

Background Bangladesh is currently a low human immunodeficiency virus (HIV) prevalent country. However, the risk factors are widespread and the number of at-risk population is also rising, which warrants special policy attention. The risks of transmission were shown to be correlated with the level of HIV knowledge of individuals. In this study, we aimed to explore the level and influencing factors of HIV knowledge among adult men in Bangladesh. Methodology Data for the present study were collected from the sixth round of Bangladesh Demographic and Health Survey. Participants were 3305 men between 15 and 54 years of age regardless of HIV status. The primary outcome variable was the HIV knowledge score, which was calculated by responses to questions regarding general concepts and the mode of transmission of HIV. Association between the HIV knowledge score and the explanatory variables were analyzed by binary logistic regression methods. Result The mean HIV knowledge score was 7.2 (SD 1.3). Results indicate that being an urban resident [p < 0.001; odds ratios (OR) = 0.56, 95% confidence intervals (CI) = 0.48–0.64], having secondary/higher educational level (p < 0.001 OR = 0.56, 95%CI = 0.48–0.64), reading newspaper [p = 0.006; OR = 0.76, 95%CI = 0.62–0.92], and communication with community health workers (CHWs) (p = 0.05; OR = 0.77, 95%CI = 0.60–10.00) were significantly associated with a high (equal or above mean value) HIV knowledge level. Conclusion The level of HIV knowledge among Bangladeshi men is low. Leveraging HIV awareness programs targeting adult men to prevent future expansion of the epidemic should be a high priority. Revitalization and restructuring of the education sector and strengthening CHW’s engagement to improve knowledge about HIV transmission among men could generate beneficial returns for HIV prevention programs.

Governance of malaria prevention: How decision-makers’ and pregnant women's sensemaking contribute to unintended consequences

ABSTRACT Although malaria in pregnancy predisposes women to increased perinatal mortality and morbidity, complex issues underlie its persistence. To develop a better understanding of the factors affecting womens access to Intermittent Preventive Treatment in Benin, we used the theoretical lens of “sensemaking” to clarify policymakers’, health professionals’, and womens perspectives concerning preventive policies and barriers to access. Several assumptions were found to underlie Benins malaria preventive policy that contribute to the unintended effect of deterring pregnant women in poverty from accessing preventive treatment. Health system dysfunctions including drug shortages and deficiencies in health care professionalism exacerbate the unintended effect.

Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review

BackgroundSocial accountability is a participatory process in which citizens are engaged to hold politicians, policy makers and public officials accountable for the services that they provide. In the Fifteenth Ordinary Session of the Assembly of the African Union, African leaders recognized the need for strong, decentralized health programs with linkages to civil society and private sector entities, full community participation in program design and implementation, and adaptive approaches to local political, socio-cultural and administrative environments. Despite the increasing use of social accountability, there is limited evidence on how it has been used in the health sector. The objective of this systematic review was to identify the conditions that facilitate effective social accountability in sub-Saharan Africa.MethodsElectronic databases (MEDLINE, PsycINFO, Sociological Abstracts, Social Sciences Abstracts) were searched for relevant articles published between 2000 and August 2017. Studies were eligible for inclusion if they were peer-reviewed English language publications describing a social accountability intervention in sub-Saharan Africa. Qualitative and quantitative study designs were eligible.ResultsFourteen relevant studies were included in the review. The findings indicate that effective social accountability interventions involve leveraging partnerships and building coalitions; being context-appropriate; integrating data and information collection and analysis; clearly defined roles, standards, and responsibilities of leaders; and meaningful citizen engagement. Health system barriers, corruption, fear of reprisal, and limited funding appear to be major challenges to effective social accountability interventions.ConclusionAlthough global accountability standards play an important guiding role, the successful implementation of global health initiatives depend on national contexts.

Turning the Tide: An Ethnographic Study of Children’s Experiences Following the Death of Their Father in Ouagadougou (Burkina Faso)

Introduction Scholars have become increasingly concerned with orphans in countries where the AIDS pandemic is most widespread, particularly in eastern and southern Africa. The loss of a parent has severe psychosocial and cognitive effects on children. It is also understood that orphans are less educated than children whose parents are alive, and have lesser performance at school. Orphans enter the labor market earlier and are more likely to form marital relationships than children whose parents are alive. It goes without saying that losing a parent leads to specific trajectories and creates a distinct family life course for orphans. In Burkina Faso, where the AIDS pandemic is less severe, little is known about the living conditions of orphans. Studies on how orphaned girls re-establish a life with meaning after the loss of a father and more specifically their coping strategies in face of difficulties are particularly rare. This study examines the complex relationships between orphaned children’s resilience, gender, and family relations in Ouagadougou (Burkina Faso).

Determinants of bed net policy implementation: A case study of Southern Benin

BACKGROUND Malaria is a major global health challenge. This study aims to clarify the manner in which contextual factors determine the use and maintenance of bed nets and the extent to which malaria prevention policy is responsive to them in Southern Benin. METHODS Semi-structured interviews and direct observations were undertaken with 30 pregnant women in the municipality of So-Ava from June to August 2015. Key informants in the Ministry of Health and local community health workers were also interviewed regarding malaria prevention policy formation, and the monitoring and evaluation of bed net interventions, respectively. Data were analyzed through categorical content analysis and grouped into themes. RESULTS The majority of pregnant women participants (80%) declared non-adherence to instructions for hanging and maintaining insecticide-treated nets (ITNs). The distributed bed nets were washed like clothes, which affected their bio-efficacy, and were in poor condition (ie, torn or had holes). Multiple factors contributed to the poor condition of ITNs: Pregnant womens limited understanding of risk including their inability to connect the key environmental factors to personal risk, gendered responsibility for installing bed nets, and lack of public measures that would enable women to re-treat or access new bed nets as needed. Poverty that determined structural aspects of housing such as the size and quality of homes and access to bed nets exacerbated the challenges. CONCLUSION Institutionalizing an iterative process of monitoring, review, and responsive adaptation throughout the entire policymaking cycle would better support malaria preventive policy implementation in Benin.

Family Ties and Mental Health of Orphans in Ouagadougou (Burkina Faso). Does the Gender of the Dead Parent Matter

In sub-Saharan Africa, families represent a type of social safety net for individuals in difficulty, thus making up for the absence of social programs and public institutions for orphaned youth. Yet the past decades have witnessed an erosion of the mechanisms of solidarity and health inequalities between orphans and non-orphaned children. This study aims to understand the family dynamics that lead to mental disorders among orphans in Burkina Faso, a landlocked and resource-limited country. A unique set of key informant interviews with 43 orphans and in-depth direct observations in informal neighborhoods were conducted from September to December 2012, transcribed and analyzed using thematic analysis techniques (Corbin and Strauss 2014). The findings reveal the assumptions concerning children’s belonging to their father’s extended family are misplaced and shed light on the unintended effects of intra-family divisions, mistrust, and harsh economic conditions of widows on the mental health of orphans, described as uprooted.