Developing an Evidence-Based Ethics Education Program for Surgical Residents in Guatemala.

Objective: This study assessed 2 modalities for teaching responsible conduct of research and human subjects protection (RCR/HSP) to surgical residents in Guatemala-an "off the shelf" online curriculum and a new in-person curriculum specific to the local context.

Methods: In 2018, 160 surgical residents in 3 large urban hospitals in Guatemala City completed 2 online programs in RCR/HSP. Residents in the intervention arm also completed 7 weeks of in-person training.

Contraceptive literacy among school-going adolescents in Botswana.

Aim: To examine adolescent contraceptive literacy and condom knowledge in Botswana.

Background: In Botswana, adolescent HIV infection rates remain high and unintended pregnancies are the predominant reason girls drop out of school. Despite a national mandate for comprehensive sexuality education and youth-friendly health services, access to accurate sexual and reproductive health information for adolescents remains limited.

Social and Behavioral Correlates of Adolescent Sexual Experience and Intention to Use Condoms in Northwestern Botswana.

Adolescent sexual behavior is shaped by individual, social, and structural factors that can increase HIV-risk, unwanted pregnancy, and sexually transmitted disease. To inform the development of a comprehensive sexuality education program, 239 secondary school adolescents ages 14-19 in Maun, Botswana, completed a survey of sexual and reproductive health knowledge, attitudes, and behaviors in February-March 2020. Bivariate and multivariate analyses examined factors associated with sexual experience and perceived ability to insist on condoms.

"It Is Like Medicine": Using Sports to Promote Adult Women's Health in Rural Kenya.

Despite the well-documented health benefits of recreational sports, few opportunities exist in lower- and middle-income countries for adult women to participate in recreational physical activities. An explanatory sequential mixed methods approach was used to explore associations between an innovative soccer program for adult women and self-reported health status. Cross-sectional survey data were collected in 2018-2019 from 702 women in the Nikumbuke Project, a health and literacy program in southeastern rural Kenya, followed by focus group discussions with 225 women who also participated in the Project's soccer program.

Exploring the Relationship Between Participation in an Adult-women's Soccer League and Intimate Partner Violence in Rural Kenya.

Rates of intimate partner violence (IPV) against women in Sub-Saharan Africa are among the highest of any region in the world. Empirical studies on the effectiveness of IPV-prevention programs in Africa, though few, suggest that successful programs have emphasized community-level engagement and attitudinal change around gender roles. This study explored the relationship between adult women's participation in an all-women's soccer league and IPV in rural Kenya.

Environmental Correlates of Health-Related Quality of Life among Women Living in Informal Settlements in Kenya.

Informal settlements (slums)-defined as residential areas lacking durable housing; sufficient living and public spaces; access to basic infrastructure, water, sanitation, and other services; and secure tenancy-are presumed to be poor health environments. Research in Kenya suggests that residents of these settlements have the worst health outcomes of any population, yet there is a paucity of research focused on the health and well-being of these residents. Even less attention is given to the role played by environment in health in these settings.

A Practical Approach to Clinical Ethics Education for Undergraduate Medical Students: A Case Study From Guatemala.

Objective: This case study describes a faculty initiative to create a curriculum in applied medical ethics for undergraduate medical students at the Universidad Francisco Marroquin (UFM) in Guatemala City, Guatemala.

Methods: The new ethics curriculum (PRACTICE) incorporates ethics short-courses into the university's system of nontraditional, credit-bearing electives offered to students as part of their 6-year undergraduate medical education and complements existing didactic courses in normative ethics. Structured case-based activities allow for flexibility in design and scheduling, do not compete with core requirements of the existing curriculum, and enable students to develop critical reasoning approaches to ethical situations they will encounter in medical practice.

Non-Partner Violence in Sub-Saharan Africa and the Built Environment: A Multicountry Analysis of the Effects of Sanitation, Water Access, and Urban Settings.

This multicountry study used Demographic and Health Surveys (DHS) data from 138,097 women to explore the relationship between non-partner violence (NPV) and sanitation, water, and urbanization in sub-Saharan Africa (SSA). One out of 15 women reports having experienced physical and/or sexual violence by a non-partner during the previous 12 months; within the region, prevalence ranges from 2.3-11.

The Role of Self-Efficacy in Women's Health-seeking Behaviors in Northwestern Botswana.

Although research assessing the role of self-efficacy in health behaviors in sub-Saharan Africa remains limited, recent research in Botswana suggests that travel time, frequency of visits, and sexual violence influence women's health-seeking. This study used cross-sectional data from 479 women collected in 2012 in Botswana to test the psychometric properties of the Generalized Self-Efficacy Scale (GSE) in Setswana, the local language, as a measure of self-efficacy. Findings confirm the GSE's validity as a unidimensional measure of self-efficacy in this population.

A mixed-methods study of women's sanitation utilization in informal settlements in Kenya.

While access to safe sanitation is a global issue, there are large disparities in access. Women living in informal settlements, in particular, are disproportionately affected by lack of access to sanitation. Without adequate sanitation, these women may resort to unsafe strategies to manage their sanitation needs, but limited research has focused specifically on this issue.

Adherence to screening appointments in a cervical cancer clinic serving HIV-positive women in Botswana.

Background: The link between human immunodeficiency virus (HIV) and cervical cancer is of particular concern in Botswana, where one in four women at risk for cervical cancer is HIV-positive. In settings where co-occurrence of these diseases is high, adherence to screening appointments is essential to ensure detection and early treatment.

Methods: This study took place in a cervical cancer-screening program in an HIV clinic in Botswana.

Exploring the complex relationship between women's sanitation practices and household diarrhea in the slums of Nairobi: a cross-sectional study.

Background: Diarrheal disease kills over half a million people each year in sub-Saharan Africa; the majority are children under 5 years. About 58% of diarrhea cases are associated with poor water, sanitation, and hygiene-a critical issue for people living in informal settlements. In Kenya, 60% of Nairobi's population lives in informal settlements; yet, there is a paucity of research exploring the relationship between water, sanitation and hygiene (WASH) conditions in these settlements and associated health outcomes.

Women's sanitation practices in informal settlements: A multi-level analysis of factors influencing utilisation in Nairobi, Kenya.

For decades, countries throughout the world have failed to meet sanitation-related development goals. Access to safe sanitation is undeniably linked to improved health outcomes; yet, 2.4 billion people, globally, still lack access.

Intimate Partner Violence and Women's Health-seeking Behaviors in Northwestern Botswana.

Despite evidence suggesting a strong association between women's experience of violence and their health-seeking behaviors, limited research has been conducted to date that explores factors associated with these behaviors in Botswana. A prospective, cross-sectional study involving semi-structured interviews with 479 women took place in Maun, Botswana, in 2012. Twenty-five percent of those interviewed reported not having visited a medical clinic at least once despite wishing to do so.

The Association of Depressive Symptoms and Intimate Partner Violence Against Women in Northwestern Botswana.

Although links between mental health and intimate partner violence (IPV) have been discussed extensively in the scholarly literature, little empirical data exist about these phenomena in Botswana. This study addressed this gap by examining the nature, extent, and risk factors associated with symptoms of major depressive disorders (MDD) using cross-sectional data collected in 2009-2010 in northwestern Botswana. A random sample of 469 women participated in semistructured interviews about their lives, health, and experiences with violence.

Drivers of women's sanitation practices in informal settlements in sub-Saharan Africa: a qualitative study in Mathare Valley, Kenya.

Despite evidence suggesting women are disproportionately affected by the lack of adequate and safe sanitation facilities around the world, there is limited information about the factors that influence women's ability to access and utilize sanitation, especially in sub-Saharan Africa. The purpose of this study was to explore factors influencing women's sanitation practices in informal settlements in Nairobi, Kenya. Information from 55 in-depth interviews conducted in 2016 with 55 women in Mathare Valley Informal Settlement in Nairobi was used to carry out cross-case, thematic analysis of women's common sanitation routines.

Context matters: a multicountry analysis of individual- and neighbourhood-level factors associated with women's sanitation use in sub-Saharan Africa.

Objectives: To identify cross-national trends in factors associated with women's sanitation use in sub-Saharan Africa.

Methods: Using data from Demographic and Health Surveys conducted in 14 SSA countries between 2008 and 2014, we modelled women's sanitation use in relation to various individual- and neighbourhood-level factors.

Results: Substantial variation exists between countries in the strength and direction of factors associated with sanitation use.

National ethics guidance in Sub-Saharan Africa on the collection and use of human biological specimens: a systematic review.

Background: Ethical and regulatory guidance on the collection and use of human biospecimens (HBS) for research forms an essential component of national health systems in Sub-Saharan Africa (SSA), where rapid advances in genetic- and genomic-based technologies are fueling clinical trials involving HBS and the establishment of large-scale biobanks.

Methods: An extensive multi-level search for publicly available ethics regulatory guidance was conducted for each SSA country. A second review documented active trials listed in the WHO International Clinical Trials Registry Platform as of January 2015 in which HBS collection was specified in the protocol.

Access to sanitation and violence against women: evidence from Demographic Health Survey (DHS) data in Kenya.

Violence against women (VAW) is a serious public health and human rights concern. Literature suggests sanitation conditions in developing countries may be potential neighborhood-level risk factors contributing to VAW, and that this association may be more important in highly socially disorganized neighborhoods. This study analyzed 2008 Kenya Demographic Health Survey's data and found women who primarily practice open defecation (OD), particularly in disorganized communities, had higher odds of experiencing recent non-partner violence.

"The keeping is the problem": A qualitative study of IRB-member perspectives in Botswana on the collection, use, and storage of human biological samples for research.

Background: Concurrent with efforts to establish national and regional biorepositories in Africa is widespread endorsement of ethics committees as stewards of the interests of individual donors and their communities. To date, ethics training programs for IRB members in Botswana have focused on ethical principles and international guidelines rather than on the ethical dimensions of specific medical technologies and research methodologies. Little is known about the knowledge and concerns of current and prospective IRB members in Botswana with respect to export, reuse, storage, and benefit-sharing of biospecimens.

Fostering IRB collaboration for review of international research.

This article presents a review of the literature, summarizes current initiatives, and provides a heuristic for assessing the effectiveness of a range of institutional review board (IRB) collaborative strategies that can reduce the regulatory burden of ethics review while ensuring protection of human subjects, with a particular focus on international research. Broad adoption of IRB collaborative strategies will reduce regulatory burdens posed by overlapping oversight mechanisms and has the potential to enhance human subjects protections.

Building research capacity in Botswana: a randomized trial comparing training methodologies in the Botswana ethics training initiative.

Background: Little empirical data are available on the extent to which capacity-building programs in research ethics prepare trainees to apply ethical reasoning skills to the design, conduct, or review of research. A randomized controlled trial was conducted in Botswana in 2010 to assess the effectiveness of a case-based intervention using email to augment in-person seminars.

Methods: University faculty and current and prospective IRB/REC members took part in a semester-long training program in research ethics.