Rachel P. Chase

Reducing child global undernutrition at scale in Sofala Province Mozambique using Care Group Volunteers to communicate health messages to mothers.

Care Group peer-to-peer behavior change communication improved child undernutrition at scale in rural Mozambique and has the potential to substantially reduce under-5 mortality in priority countries at very low cost. Care Group peer-to-peer behavior change communication improved child undernutrition at scale in rural Mozambique and has the potential to substantially reduce under-5 mortality in priority countries at very low cost. Background: Undernutrition contributes to one-third of under-5 child mortality globally. Progress in achieving the Millennium Development Goal of reducing under-5 mortality is lagging in many countries, particularly in Africa. This paper shares evidence and insights from a low-cost behavior-change innovation in a rural area of Mozambique. Intervention: About 50,000 households with pregnant women or children under 2 years old were organized into blocks of 12 households. One volunteer peer educator (Care Group Volunteer, or CGV) was selected for each block. Approximately 12 CGVs met together as a group every 2 weeks with a paid project promoter to learn a new child-survival health or nutrition message or skill. Then the CGVs shared the new message with mothers in their assigned blocks. Methods of evaluation: Household surveys were conducted at baseline and endline to measure nutrition-related behaviors and childhood nutritional status. Findings: More than 90% of beneficiary mothers reported that they had been contacted by CGVs during the previous 2 weeks. In the early implementation project area, the percentage of children 0–23 months old with global undernutrition (weight-for-age with z-score of less than 2 standard deviations below the international standard mean) declined by 8.1 percentage points (P<0.001), from 25.9% (95% confidence interval [CI] = 22.2%–29.6%) at baseline to 17.8% at endline (95% CI = 14.6%–20.9%). In the delayed implementation area, global undernutrition declined by 11.5 percentage points (P<0.001), from 27.1% (95% CI = 23.6%–30.6%) to 15.6% (95% CI = 12.6%–18.6%). Total project costs were US

Population estimates of undocumented incident traumatic brain injuries among combat-deployed US military personnel.

3.0 million, representing an average cost of US

Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India.

0.55 per capita per year (among the entire population of 1.1 million people) and US

Development of A Multidimensional Scale to Assess Attitudinal Determinants of Sanitation Uptake and Use.

2.78 per beneficiary (mothers with young children) per year. Conclusion: Using the Care Group model can improve the level of global undernutrition in children at scale and at low cost. This model shows sufficient promise to merit further rigorous testing and broader application.

Reassuring or risky: The presentation of seafood safety in the aftermath of the British Petroleum deepwater horizon oil spill

Objective:To estimate the number of undocumented incident traumatic brain injuries (TBIs) among active component US military personnel serving in Iraq and Afghanistan prior to policy changes implemented in late 2006 and 2010 that improved TBI documentation. Methods:Negative binomial regression was used to model monthly incident TBI counts between December 2010 and June 2012 (N = 19) and then estimate expected monthly counts of incident TBIs during 2 periods: January 2003-October 2006 and November 2006-November 2010. Monthly amputation counts from Department of Defense surveillance data were used as a proxy for changing injury rates. Monthly active component deployment estimates derived from the Congressional Research Service, Brookings Institution, and Defense Manpower Data Center were used to estimate the size of the at-risk population each month. The difference between expected monthly incident TBI counts and reported counts is presented as the estimated number of undocumented incident TBIs. Results:The full model estimates that 21 257 active component military personnel experienced undocumented incident TBIs while deployed in Iraq or Afghanistan between January 2003 and October 2006, more than 4 times the 5272 incident TBIs documented during that period. Conclusions:A sizeable majority of Iraq and Afghanistan combat veterans who experienced incident TBI while deployed prior to November 2006 are likely to have had their injuries undocumented, creating challenges for clinical care, disability evaluation, and future research.

Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi

Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women’s reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention.

Tell Me What You Don't Remember: Care-Seeking Facilitators and Barriers in the Decade Following Repetitive Blast Exposure Among Army Combat Veterans

Over 1 billion people still practice open defecation. Low uptake and use of new sanitation technologies in a number of settings has underscored our current limited understanding of the complex attitudinal factors that influence a households decision to adopt and use new sanitation technologies. Mokken scaling techniques were applied to series of population-based surveys in Odisha, India between September 2011 and October 2013 (sample sizes 120, 500, 2200). Surveys contained simple, agree/disagree statements about attitudes toward sanitation use and sanitation technologies. Analysis produced two scales-a 10-question General Scale, reflecting attitudes toward defecation and norms regarding latrine use for all respondents, and a 6-question Experiential Scale, reflecting personal experiences with and perceived convenience of sanitation technologies targeted at respondents with a latrine. Among all respondents, a one-point change in the General Scale was associated with a 5-percentage point change in the marginal probability of having access to a functioning latrine. Among respondents with a functional latrine at home, a one-point increase in the General and Experiential Scales were associated with a 4- and 8-percentage point decrease in the probability of engaging in any open defecation in the last 7 days, respectively.

Child's play: Harnessing play and curiosity motives to improve child handwashing in a humanitarian setting

The BP Deepwater Horizon Oil Spill was enormously newsworthy; coverage interlaced discussions of health, economic, and environmental impacts and risks. We analyzed 315 news articles that considered Gulf seafood safety from the year following the spill. We explored reporting trends, risk presentation, message source, stakeholder perspectives on safety, and framing of safety messages. Approximately one third of articles presented risk associated with seafood consumption as a standalone issue, rather than in conjunction with environmental or economic risks. Government sources were most frequent and their messages were largely framed as reassuring as to seafood safety. Discussions of prevention were limited to short-term, secondary prevention approaches. These data demonstrate a need for risk communication in news coverage of food safety that addresses the larger risk context, primary prevention, and structural causes of risk.

Water, Sanitation, And Primary School Attendance: A Multi-Level Assessment Of Determinants Of Household-Reported Absence In Kenya

Available data suggest that individual and family well-being are linked to the quality of women’s and men’s couple relationships, but few tools exist to assess couple relationship functioning in low- and middle-income countries. In response to this gap, Catholic Relief Services has developed a Couple Functionality Assessment Tool (CFAT) to capture valid and reliable data on various domains of relationship quality. This tool is designed to be used by interventions which aim to improve couple and family well-being as a means of measuring the effectiveness of these interventions, particularly related to couple relationship quality. We carried out a validation study of the CFAT among 401 married and cohabiting adults (203 women and 198 men) in rural Chikhwawa District, Malawi. Using psychometric scales, the CFAT addressed six domains of couple relationship quality (intimacy, partner support, sexual satisfaction, gender roles, decision-making, and communication and conflict management), and included questions on intimate partner violence. We used exploratory factor analysis to assess scale performance of each domain and produce a shortened Relationship Quality Index (RQI) composed of items from five relationship quality domains. This article reports the performance of the RQI. Internal reliability and validity of the RQI were found to be good. Regression analyses examined the relationship of the RQI to outcomes important to health and development: intra-household cooperation, positive health behaviors, intimate partner violence, and gender-equitable norms. We found many significant correlations between RQI scores and these couple- and family-level development issues. There is a need to further validate the tool with use in other populations as well as to continue to explore whether the observed linkages between couple functionality and development outcomes are causal relationships.

Nègènègèn: Sweet talk, disrespect, and abuse among rural auxiliary midwives in Mali.

OBJECTIVES This study sought to understand facilitators and barriers to care seeking among blast-exposed veterans and service members who served before the implementation of systematic screening for traumatic brain injury. METHODS Informed by principles of Grounded Theory, we used theoretical sampling and conducted 31 interviews with 15 veterans and 10 veteran family members. Data were iteratively collected and thematically analyzed. RESULTS The most critical facilitator in initiating care was encouragement--verging on insistence--from a spouse, family member, or employer. Although respondents overwhelmingly described veteran and military health systems responding inadequately to patient needs, respondents also described exceptional health professionals who stood in contrast, dedicated to providing quality care. Barriers to ongoing care included: scheduling complications; redeployments; insufficient or inaccessible documentation of blast encounters or medical history; high provider turnover interrupting therapeutic progress; and poor patient-provider relationships. Respondents described providers as generally dismissive of or insensitive to many health needs. Respondents feared the system was incapable of helping them and described stigma against mental health care seeking in personal and professional spheres. CONCLUSIONS Veterans and their families struggle to address multiple, confusing transformations after repetitive blast exposures. Complex, impersonal, and skeptical health system processes place an undue burden on care-seeking veterans and service members.