A comparative study of adult and adolescent maternal care continuum following community-oriented interventions in Cambodia, Guatemala, Kenya, and Zambia.

Background: The coverage for reproductive care continuum is a growing concern for communities in low- income economies. Adolescents (15-19 years) are often at higher odds of maternal morbidity and mortality due to other underlying factors including biological immaturity, social, and economic differences. The aim of the study was to examine a) differences in care-seeking and continuum of care (4 antenatal care (ANC4+), skilled birth attendance (SBA) and postnatal care (PNC) within 24h) between adult (20-49 Years) and adolescents and b) the effect of multilevel community-oriented interventions on adolescent and adult reproductive care-seeking in Cambodia, Guatemala, Kenya, and Zambia using a quasi-experimental study design.

Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia.

Background: Skilled attendance at delivery is a key marker for reducing maternal mortality. Effective community engagement strategies complemented by community health worker (CHW) services can improve access to maternal health services in areas with limited health infrastructure or workforce.

Methods: A quasi-experimental study with matched comparison groups was conducted in Cambodia, Kenya and Zambia to determine the effect of integrated community investments on skilled birth attendance (SBA).

Can social accountability mechanisms using community scorecards improve quality of pediatric care in rural Cambodia?

Objective: To determine the effect of social accountability strategies on pediatric quality of care.

Design And Setting: A non-randomized quasi experimental study was conducted in four districts in Cambodia and all operational public health facilities were included.

Participants: Five patients under 5 years and their caretakers were randomly selected in each facility.

Association of mother's handwashing practices and pediatric diarrhea: evidence from a multi-country study on community oriented interventions.

Introduction: Improved hand hygiene in contexts with high levels of diarrheal diseases has shown to reduce diarrheal episodes in children under five years. A quasi-experimental multi-country study with matched comparisons was conducted in four rural districts/sub districts in Cambodia, Guatemala, Kenya and Zambia.

Methods: Community oriented interventions including health promotion for appropriate hand washing was implemented in the intervention sites, through community health workers (CHW) and social accountability mechanisms.

Comprehensive care and HIV prophylaxis after sexual assault in rural South Africa: the Refentse intervention study.

Problem: Although international guidelines specify the central role of the health sector in providing comprehensive care, including HIV post-exposure prophylaxis (PEP), after sexual assault, in both industrialised and developing countries there are many challenges to providing timely and comprehensive services.

Design: A nurse driven model of post-rape care was integrated into existing hospital services; the before and after study design evaluated impacts on quality of care, reviewing 334 hospital charts and conducting interviews with 16 service providers and 109 patients.

Setting: 450 bed district hospital in rural South Africa.

Condom use and its association with HIV/sexually transmitted diseases in four urban communities of sub-Saharan Africa.

Objectives: To estimate rates of condom use in four urban populations in sub-Saharan Africa and to assess their association with levels of HIV infection and other sexually transmitted diseases (STDs).

Methods: Data were obtained from a multicentre study of factors that determine the differences in rate of spread of HIV in four African cities. Consenting participants were interviewed on sexual behaviour, and also provided blood and urine samples for testing for HIV infection and other STDs.

Commercial sex and the spread of HIV in four cities in sub-Saharan Africa.

Objective: To examine whether commercial sex transactions were more common and/or transmission between sex workers and clients more efficient in two African cities with high HIV prevalence (Kisumu, Kenya and Ndola, Zambia) compared with two with relatively low HIV prevalence (Cotonou, Benin and Yaoundé, Cameroon).

Methods: Data on sexual behaviour, HIV and sexually transmitted infections were collected from representative samples of around 300 female sex workers in each city. Sexual behaviour data from a population-based study of around 1000 men aged 15-49 in each city were used to estimate the extent of contact with sex workers.

Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia.

Objective: To examine the factors responsible for the disparity in HIV prevalence between young men and women in two urban populations in Africa with high HIV prevalence.

Design: Cross-sectional survey, aiming to include 1000 men and 1000 women aged 15-49 years in Kisumu, Kenya and Ndola, Zambia.

Methods: Participants were interviewed and tested for HIV and other sexually transmitted infections.

Multicentre study on factors determining differences in rate of spread of HIV in sub-Saharan Africa: methods and prevalence of HIV infection.

Objective: The objective of this study was to explore whether the differences in rate of spread of HIV in different regions in sub-Saharan Africa could be explained by differences in sexual behaviour and/or factors influencing the probability of HIV transmission during sexual intercourse.

Methods: A cross-sectional, population-based study was conducted in two cities with a high HIV prevalence (Kisumu in Kenya and Ndola in Zambia) and two cities with a relatively low HIV prevalence (Cotonou in Benin and Yaoundé in Cameroon). In each of these cities, approximately 1000 men and 1000 women, aged 15-49 years, were randomly selected from the general population.

Comparison of key parameters of sexual behaviour in four African urban populations with different levels of HIV infection.

Objective: To explore whether differences in sexual behaviour could explain differences in the rate of spread of HIV in four urban populations in Africa.

Methods: A cross-sectional, population-based study was conducted in two cities where the prevalence of HIV among adults exceeded 20% (Kisumu, Kenya and Ndola, Zambia) and two cities with a much lower HIV prevalence among adults (Cotonou, Benin and Yaoundé, Cameroon). In each of these cities, approximately 1000 men and 1000 women, aged 15-49 years, were randomly selected from the general population.

Male circumcision and HIV infection in four cities in sub-Saharan Africa.

Objectives: To explore the role of male circumcision in the spread of HIV infection in four urban populations in sub-Saharan Africa.

Design And Methods: A cross-sectional population based study was conducted in four cities in sub-Saharan Africa with different levels of HIV infection. HIV prevalence among adults was relatively low in Cotonou (Benin) and in Yaoundé (Cameroon), and exceeded 25% in Kisumu (Kenya) and in Ndola (Zambia).

Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection.

Objective: To identify factors that could explain differences in rate of spread of HIV between different regions in sub-Saharan Africa.

Design: Cross-sectional study.

Methods: The study took place in two cities with a relatively low HIV prevalence (Cotonou, Benin and Yaoundé, Cameroon), and two cities with a high HIV prevalence (Kisumu, Kenya and Ndola, Zambia).

Interpreting sexual behaviour data: validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities.

Background: The main conclusion of the multicentre study on factors determining the differential spread of HIV in four African cities was that differences in sexual behaviour could not, by themselves, explain the differences in HIV prevalence between the four cities. The present paper examines three potential sources of bias that could invalidate this conclusion: (1) changes in sexual behaviour since the start of the HIV epidemics; (2) bias due to the low response rates of men; and (3) bias in reported sexual behaviour.

Methods: To assess whether there have been any changes in sexual behaviour over time, selected parameters of sexual behaviour were compared between different age groups in the four cities.

Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa.

Objective: To estimate parameters of concurrent sexual partnerships in five urban populations in sub-Saharan Africa and to assess their association with levels of HIV infection and other sexually transmitted infections (STI).

Methods: Data were obtained from a multicentre study of factors which determine the differences in rate of spread of HIV in five African cities. Consenting participants were interviewed on sexual behaviour and at four of the five sites also provided a blood and a urine sample for testing for HIV and other STI.

The relative bioavailability of salbutamol to the lung using urinary excretion following inhalation from a novel dry powder inhaler: the effect of inhalation rate and formulation.

Each dry powder inhaler has a different resistance so that a respirable dose can be generated from the formulation by the patient's inspiratory effort. It is important to recognize that this effect is achievable. The inspiratory flow characteristics of asthmatics inhaling through a Clickhaler were determined.

Volumatic usage: some generic salbutamol metered dose inhalers can be used.

Background: The 30 minute and 24 hour post-inhalation urinary excretion of salbutamol represents the relative amount of drug deposited in the lungs and total systemic absorption, respectively. Using this method two metered dose inhalers used with a Volumatic (Allen and Hanburys Ltd, UK) large volume spacer have been compared.

Method: Eleven healthy volunteers inhaled 4 x 100 micrograms salbutamol from either a generic salbutamol (Baker Norton, UK) or Ventolin (Allen and Hanburys Ltd, UK) metered dose inhaler with a Volumatic.