May Sudhinaraset

When a Parent Goes Off to War: Exploring the Issues Faced by Adolescents and Their Families.

The objectives of this study were (1) to explore the consequences of parental deployment for adolescents and their families and (2) to identify potential strategies that may help adolescents cope with a parents deployment. Eleven focus groups were conducted among adolescents in military families, military parents, and school personnel in military-impacted schools at five military bases. Findings reveal that one of the most prominent sources of stress for families is adjusting and readjusting to new roles and responsibilities. Notably, this stress was primarily felt after the deployed parent returned. School personnel also commented that many teachers and counselors are not prepared to deal with deployment issues among the military students. These findings suggest that parents need to be better prepared to handle the stresses after a deployed parent returns. School personnel also need special training, and military-impacted schools need to offer additional opportunities for students to discuss deployment issues.

What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review

Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector. To address this gap we conducted a comprehensive literature review on the informal health care sector in developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for data abstraction. Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on quality is notably incomplete and poor quality of care is generally assumed. There was a wide variation in how quality of care is measured. The review found that IPs reported inadequate drug provision, poor adherence to clinical national guidelines, and that there were gaps in knowledge and provider practice; however, studies also found that the formal sector also reported poor provider practices. Reasons for using IPs included convenience, affordability, and social and cultural effects. Recommendations from the literature amount to a call for more engagement with the IP sector. IPs are a large component of nearly all developing country health systems. Research and policies of engagement are needed.

Youth at Risk: Suicidal Thoughts and Attempts in Vietnam, China, and Taiwan

PURPOSE Despite increasing rates of suicide among youth in Asian cultures, there is a lack of suicide data among 15-24 year-olds, and little is known about the risk and protective factors for suicidality. This study examines the prevalence of suicidal ideation and attempts among 15-24 year-olds and identifies the sociodemographic correlates of suicidality in Hanoi, Shanghai, and Taipei. METHODS A cross-sectional survey of 17,016 youth aged 15-24 years was conducted in rural and urban areas of Hanoi, Vietnam; Shanghai, China; and Taipei, Taiwan in 2006. Logistic regression was used to analyze correlates of suicidal ideation and attempt across cities. RESULTS The 12-month prevalence of suicidal ideation and attempt was 8.4% and 2.5% across all three cities, respectively. Suicidal ideation was highest in Taipei (17.0%), Shanghai (8.1%), and lowest in Hanoi (2.3%); similar trends were found for suicidal attempts. Younger age cohorts (15-19 year-olds) and females were more likely to report suicidal ideation and suicidal attempts compared with 20-24 year-olds and males. In multivariate logistic regression results, across the three cities, female gender, younger age, family structure, parental support, family history of suicide, migration status, and substance use were associated with suicidal ideation. Factors associated with suicidal attempt included female gender, family history of suicide, parental support, and substance use. DISCUSSION Suicidality is common among Asian youth, with highest levels reported in more industrialized cities.

Migration and Unprotected Sex in Shanghai, China: Correlates of Condom Use and Contraceptive Consistency Across Migrant and Nonmigrant Youth

PURPOSE Despite the exceptionally large population of young migrants in China, as well as increasing rates of HIV and sexually transmitted infections in recent years, condom use and contraceptive consistency among this population remains critically under-studied. This study examines the association between migration and condom use and contraceptive consistency. METHODS A cross-sectional survey of 959 youth aged 15-24 years was conducted in rural and urban Shanghai. Logistic regression was conducted to examine the association between migration status and condom use and consistent contraceptive use. Analyses are stratified by gender. RESULTS Overall, only 32% reported condom use at first sex, and <10% reported consistent contraceptive use. Compared with 63.6% of urban nonmigrants, 83.1% of rural-to-urban migrants reported not using a condom at first sex. Multivariate logistic regression models indicate that patterns of migration and gender clearly impact condom use and contraceptive consistency. After adjusting for background characteristics, rural-to-urban migrant males were significantly less likely to report condom use at first sex and consistent contraceptive use with first partner compared with nonmigrants and urban-to-urban migrants. Females living in rural areas who never migrate, by contrast, are least likely to report condom use and consistent contraceptive use compared with other females. CONCLUSION Because rural men who migrate to urban areas and rural nonmigrant young women are at particular risk, programs should target rural areas for both of these groups that would give support to young men before they leave their hometowns, as well as focusing on females who might not have the opportunity to migrate.

Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: Qualitative findings from mothers, grandmothers, and husbands

BACKGROUND Myanmar has low rates of exclusive breastfeeding despite many decades of efforts to increase this practice. The purpose of this study is to examine the barriers to exclusive breastfeeding and how different household members participate in decision-making. METHODS We conducted semi-structured interviews with mothers with an infant 6-12 months (24), and a subset of their husbands (10) and their mothers/mothers-in-laws (grandmothers) (10) in rural and urban areas of Laputta, Myanmar. RESULTS Respondents had high levels of knowledge about exclusive breastfeeding, but low adherence. One of the primary barriers to exclusive breastfeeding was that mothers, husbands, and grandmothers believed that exclusive breastfeeding was not sufficient for babies and solid foods and water were necessary. Water and mashed up rice were commonly introduced before 6 months of age. Mothers also faced barriers to exclusive breastfeeding due to the need to return to work outside the home and health related problems. Other family members provide support for mothers in their breastfeeding, however, most respondents stated that decisions about breastfeeding and child feeding were made by the mother herself. CONCLUSIONS Mothers in this part of Myanmar know about exclusive breastfeeding, but need more knowledge about its importance and benefits to encourage them to practice it. More information for other family members could improve adherence to exclusive breastfeeding, as family members often provide food to children and support to breastfeeding mothers. Support for mothers to be able to continue breastfeeding once they return to work and in the face of health problems is also important. Finally, additional information about the types of foods that infants need once they cease breastfeeding could improve infant and child health.

Drivers of facility deliveries in Africa and Asia: regional analyses using the demographic and health surveys.

BackgroundIn the past few decades many countries have worked to increase the number of women delivering in facilities, with the goal of improving maternal and neonatal health outcomes. The purpose of this study is to explore the current situation of facility deliveries in Africa and Asia to understand where and with whom women deliver. Furthermore, we aim to test potential drivers of facility delivery at the individual, household, and community-level.MethodsDemographic and Health Survey data collected since 2003 from 43 countries in Africa and Asia is explored to understand the patterns of where women are delivering. We look at patterns by region and wealth quintile and urban/rural status. We then run a series of multi-level models looking at relationships between individual, household and community-level factors and the odds of a woman delivering in a facility. We explore this for Asia and Africa separately. We also look at correlates of delivery with a trained provider, in a public facility, in a private facility, with a doctor and in a hospital.ResultsThe majority of women deliver in a facility and with a provider; however, about 20% of deliveries are still with no one or a friend/relative or alone. Rates of facility delivery are lower in Asia overall, and a greater proportion of deliveries take place in private facilities in Asia compared to Africa. Most of the individual level factors that have been found in past studies to be associated with delivering in a facility hold true for the multi-country-level analyses, and small differences exist between Asia and Africa. Women who deliver in private facilities differ from women who deliver in public facilities or at home.ConclusionsMost women in Africa and Asia are delivering in a facility, and drivers of facility delivery identified in smaller level or country specific studies hold true in multi-country national level data. More data and research is needed on other drivers, especially at the country-level and relating to the quality of care and maternal health complications.

Neuromaturation and Adolescent Risk Taking: Why Development Is Not Determinism

In the January 2009 issue of this journal, Males argues that adolescent brain science perpetuates the “myth of adolescent risk taking.” He contends that those who study adolescent neuromaturation are biological determinists who ignore the profound social and environmental forces that influence adolescent behavior to further their own agendas. Males mischaracterizes developmental research and misinterprets public health data. This article analyzes his argument and provides a response based on the evidence. There is significant cross-species evidence that adolescence serves an important developmental function on the road to full maturation and is not merely an oppressive social construction. Research on neuromaturation can help elucidate both the vulnerabilities and tremendous potential of the adolescent brain. It also provides the opportunity to examine the role of social environments in shaping developmental processes and to explore how reasoned understandings of adolescent brain and biological development are being used to inform interventions that scaffold adolescent vulnerabilities.

Improving uptake and use of malaria rapid diagnostic tests in the context of artemisinin drug resistance containment in eastern Myanmar: An evaluation of incentive schemes among informal private healthcare providers

BackgroundAs efforts to contain artemisinin resistance and eliminate Plasmodium falciparum intensify, the accurate diagnosis and prompt effective treatment of malaria are increasingly needed in Myanmar and the Greater Mekong Sub-region (GMS). Rapid diagnostic tests (RDTs) have been shown to be safe, feasible, and effective at promoting appropriate treatment for suspected malaria, which are of particular importance to drug resistance containment. The informal private sector is often the first point of care for fever cases in malaria endemic areas across Myanmar and the GMS, but there is little published information about informal private provider practices, quality of service provision, or potential to contribute to malaria control and elimination efforts. This study tested different incentives to increase RDT use and improve the quality of care among informal private healthcare providers in Myanmar.MethodsThe study randomized six townships in the Mon and Shan states of rural Myanmar into three intervention arms: 1) RDT price subsidies, 2) price subsidies with product-related financial incentives, and 3) price subsidies with intensified information, education and counselling (IEC). The study assessed the uptake of RDT use in the communities by cross-sectional surveys of 3,150 households at baseline and six months post-intervention (6,400 households total, 832 fever cases). The study also used mystery clients among 171 providers to assess quality of service provision across intervention arms.ResultsThe pilot intervention trained over 600 informal private healthcare providers. The study found a price subsidy with intensified IEC, resulted in the highest uptake of RDTs in the community, as compared to subsidies alone or merchandise-related financial incentives. Moreover, intensified IEC led to improvements in the quality of care, with mystery client surveys showing almost double the number of correct treatment following diagnostic test results as compared to a simple subsidy.ConclusionsResults show that training and quality supervision of informal private healthcare providers can result in improved demand for, and appropriate use of RDTs in drug resistance containment areas in eastern Myanmar. Future studies should assess the sustainability of such interventions and the scale and level of intensity required over time as public sector service provision expands.

The relationship between women's experiences of mistreatment at facilities during childbirth, types of support received and person providing the support in Lucknow, India

BACKGROUND a growing body of literature has highlighted the prevalence of mistreatment that women experience around the globe during childbirth, including verbal and physical abuse, neglect, lack of support, and disrespect. Much of this has been qualitative. Research around the world suggests that support during childbirth can improve health outcomes and behaviours, and improve experiences. Support can be instrumental, informational, or emotional, and can be provided by a variety of people including family (husbands, mothers) or health providers of various professional levels. This study explores womens reported experiences of mistreatment during childbirth quantitatively, and how these varied by specific types of support available and provided by specific individuals. METHODS participants were women age 16-30 who had delivered infants in a health facility in the previous five years and were living in slums of Lucknow India. Data were collected on their experiences of mistreatment, the types of support they received, and who provided that support. RESULTS women who reported lack of support were more likely to report mistreatment. Lack of support in regards to discussions with providers and provider information were most strongly associated with a higher mistreatment score. Women who received any type of support from their husband or a health worker were significantly more likely to report lower mistreatment scores. Receiving informational support from a mother/mother-in-law or emotional support from a health worker was also associated with lower mistreatment scores. However, receiving emotional support from a friend/neighbour/other family member was associated with a higher mistreatment score. CONCLUSIONS women rely on different people to provide different types of support during childbirth in this setting. Some of these individuals provide specific types of support that ultimately improve a womans overall experience of her childbirth. Interventions aiming to reduce mistreatment to women during childbirth should consider the important role of increasing support for women, and who might be the most appropriate person to provide the most essential types of support through this process.

Improving malaria knowledge and practices in rural Myanmar through a village health worker intervention: a cross-sectional study

BackgroundSince 2008 the Sun Primary Health (SPH) franchise programme has networked and branded community health workers in rural Myanmar to provide high quality malaria information and treatment. The purpose of this paper is to compare the malaria knowledge level and health practices of individuals in SPH intervention areas to individuals without SPH interventionMethodsThis study uses data from a cross-sectional household survey of 1,040 individuals living in eight rural townships to compare the knowledge level of individuals in SPH intervention areas to individuals without SPH intervention.ResultsThis study found that the presence of a SPH provider in the community is associated with increased malaria knowledge and higher likelihood of going to trained providers for fevers. Furthermore, the study found a dose–response, where the longer the duration of the programme in a community, the greater the community knowledge level.ConclusionThe study suggests that community health workers might have significant impact on malaria-related mortality and morbidity in rural Myanmar.