Barriers to appropriate complementary feeding and the use of ultra-processed foods: A formative qualitative study from rural Oromia, Ethiopia.

Children's consumption of ultra-processed foods (UPF) is increasing in Ethiopia, but relatively little is known about the specific feeding practices that underlie this pattern. The objective of this study was to explore patterns of consumption of UPF by infants and young children within a broader context of inappropriate complementary feeding practices in extremely poor households in rural Oromia, Eastern Ethiopia. A formative qualitative study was conducted using semistructured interview questionnaires developed drawing on a socioecological model.

Effectiveness of community mobilisation and group-based interventions for preventing intimate partner violence against women in low- and middle-income countries: A systematic review and meta-analysis.

Background: Intimate partner violence (IPV) is a challenge affecting one in three women in their lifetime, and gender-transformative interventions have been identified as a promising prevention strategy. We systematically reviewed and meta-analysed randomised controlled trials (RCTs) of community-level or group-based interventions to prevent IPV in lower- and middle-income countries, seeking to answer the following research question: do community- or group-based gender-transformative interventions reduce IPV, compared to a control arm of status-quo programming?

Methods: We conducted a systematic search from the inception of all databases employed until 20 July 2021. Eligible study outcomes included past-year experience of physical, sexual, emotional or economic IPV self-reported by women and perpetration of physical or sexual IPV self-reported by men.

COVID-19 school closures and mental health of adolescent students: Evidence from rural Mozambique.

The onset of the COVID-19 pandemic, entailing widespread school closures as well as acute disruptions to household livelihoods, had substantial consequences for adolescent well-being in low-income countries. We present novel evidence about the prevalence of mental health challenges among adolescent students in rural Mozambique using data from an in-person survey conducted in 105 schools in 2021, immediately following the post-pandemic school reopening. In our sample, 31% of students reported low levels of well-being (though only 10% suffer from high anxiety): students enrolled in schools that used a wider variety of distance learning measures and who had more robust social networks reported lower anxiety, while students who experienced household-level disruptions linked to the pandemic reported higher anxiety and lower well-being.

Women's empowerment, maternal depression, and stress: Evidence from rural Burkina Faso.

Objective: Though there is a wide array of evidence that women's empowerment is associated with more positive health and nutritional outcomes for women and children, evidence around the relationship with mental health or subjective well-being remains relatively limited. The objective of this paper is to explore this relationship in longitudinal data from rural Burkina Faso.

Methods: We analyze the association between empowerment measured using the project-level Women's Empowerment in Agriculture Index (pro-WEAI), and two additional outcomes of interest: stress (measured using the SRQ-20) and maternal depression (measured using the Edinburgh scale for post-partum depression).

The effects of text reminders on the use of family planning services: evidence from a randomised controlled trial in urban Mozambique.

Introduction: Reduction of unmet need for contraception is associated with enhanced health outcomes. We conducted a randomised controlled trial in Mozambique analysing the effects of text messages encouraging use of family planning services.

Methods: This trial was conducted within a sample of women served by the Integrated Family Planning Program implemented by Population Services International, in which community health workers provide clinic referrals for family planning services.

Predictors of Discordance and Concordance in Reporting of Intimate Partner Violence: Evidence From a Large Sample of Rural Ethiopian Couples.

Intimate partner violence (IPV) is a major worldwide health challenge, and addressing this challenge requires high-quality data. This analysis uses a large-scale survey of 5033 households in rural Ethiopia in which both men and women were surveyed about past-year IPV in order to quantify the degree of discordance, including both husband only reporting and wife only reporting, for multiple forms of IPV (emotional, physical, and sexual). In addition, logistic regression is employed to analyze the effects of demographic characteristics and individual norms and behaviors on the probability of discordant reporting.

How light is too light touch: The effect of a short training-based intervention on household poultry production in Burkina Faso.

This paper reports on the effects of a training-based intervention seeking to increase household engagement in poultry production in Burkina Faso, analyzing data from a large-scale cluster randomized trial in which 1798 households in 60 communes were observed over a period of three years. The intervention SELEVER - entailing a short series of trainings for households as well as capacity building for local animal health and credit services - had little effect on household poultry production and no effect on profits. There is some evidence of an increase in the utilization of poultry inputs and an associated reduction in poultry mortality, primarily for larger poultry producers; however, there is no evidence of any treatment effects for the smallest producers.

Cost-effectiveness analysis of an intimate partner violence prevention intervention targeting men, women and couples in rural Ethiopia: evidence from the Unite for a Better Life randomised controlled trial.

Objectives: Experience of intimate partner violence (IPV) is associated with adverse health and psychosocial outcomes for women. However, rigorous economic evaluations of interventions targeting IPV prevention are rare. This paper analyses the cost-effectiveness of Unite for a Better Life (UBL), a gender-transformative intervention designed to prevent IPV and HIV risk behaviours among men, women and couples.

Short-term effects of the COVID-19 state of emergency on contraceptive access and utilization in Mozambique.

The COVID-19 pandemic has increasingly disrupted the global delivery of preventive health care services, as a large number of governments have issued state of emergency orders halting service delivery. However, there is limited evidence on the realized effects of the pandemic and associated emergency orders on access to services in low-income country contexts to date. To address this gap, this paper analyzes administrative data on utilization of contraceptive health services by women referred via community health promoters in two large urban and peri-urban areas of Mozambique.

Intimate partner violence and maternal health services utilization: evidence from 36 National Household Surveys.

Background: High rates of maternal mortality and intimate partner violence (IPV) are both major worldwide health challenges. Evidence from single-country samples suggests that IPV may be an important risk factor for low utilization of maternal health services, but there is little large-scale evidence on this association. This paper evaluates whether IPV is a risk factor for low utilization of maternal health services in a large cross-country sample, and also compiles evidence on the relative effects of different forms of IPV.

Community-level spillover effects of an intervention to prevent intimate partner violence and HIV transmission in rural Ethiopia.

Background: Intimate partner violence (IPV) is associated with adverse health and psychosocial outcomes. We analysed the spillover effects of Unite for a Better Life (UBL), an intervention evaluated in a cluster randomised controlled trial using a double-randomised design; previous evidence suggests UBL reduced IPV in rural Ethiopia among direct beneficiaries.

Methods: Villages (n=64) were randomly allocated to control, or to receive UBL delivered to men, women or couples.

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial.

Background: Intimate partner violence (IPV) is linked to substance use by male perpetrators and is associated with an increased risk of depression for women who experience violence. Unite for a Better Life (UBL) is a gender-transformative intervention delivered to men, women, and couples in Ethiopia; previous evidence demonstrated the intervention significantly reduced experience of and perpetration of IPV when delivered to men and led to more equitable household task-sharing when delivered to men and couples. The aim of this analysis is to assess engagement in the UBL intervention and to examine the relationship between random assignment to the intervention and men's past-year substance use and women's reported depressive symptoms as measured at the individual level.

Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial.

Background: Intimate partner violence (IPV) is associated with increased HIV risk and other adverse health and psychosocial outcomes. We assessed the impact of Unite for a Better Life (UBL), a gender-transformative, participatory intervention delivered to men, women, and couples in Ethiopia in the context of the coffee ceremony, a traditional community-based discussion forum.

Methods And Findings: Villages (n = 64) in 4 Ethiopian districts were randomly allocated to control, men's UBL, women's UBL, or couples' UBL, and approximately 106 households per village were randomly selected for inclusion in the trial.

Framing Flexible Spending Accounts: A Large-Scale Field Experiment on Communicating the Return on Medical Savings Accounts.

Tax-preferred health savings devices such as Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) offer employees potentially valuable financial instruments for directing pre-tax earnings to eligible medical expenses. Despite their increasing popularity as an employee benefit, however, there is little causal evidence around individual demand for these accounts. This paper seeks to address this gap in the literature, reporting on a randomized controlled field experiment conducted with over 11,000 U.

"That's a woman's problem": a qualitative analysis to understand male involvement in maternal and newborn health in Jigawa state, northern Nigeria.

Background: Maternal and newborn mortality continue to be major challenges in Nigeria. While greater participation of men in maternal and newborn health has been associated with positive outcomes in many settings, male involvement remains low. The objective of this analysis was to investigate male involvement in maternal and newborn health in Jigawa state, northern Nigeria.

Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial.

Background: The burden of maternal and neonatal mortality remains persistently high in Nigeria. Sepsis contributes significantly to both maternal and newborn mortality, and safe delivery kits have long been promoted as a cost-effective intervention to ensure hygienic delivery practices and reduce sepsis. However, there is limited evidence on the effectiveness of home birth kit distribution by community health workers, and particularly the impact of this intervention on health outcomes.

Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Jigawa State, Northern Nigeria.

Background: Maternal mortality and newborn mortality continue to be major challenges in Nigeria, with the highest levels in the northern part of the country. The objective of this study was to explore the process and sequence of symptom recognition, decision-making, and care-seeking among families experiencing maternal and neonatal illness and deaths in 24 local governmental areas in Jigawa State, Northern Nigeria.

Methods: This qualitative study included 40 illness narratives (ten each for maternal deaths, perceived postpartum hemorrhage (PPH), neonatal deaths, and neonatal illness) that collected data on symptom recognition, perceptions of the causes of disease, decision-making processes, the identity of key decision-makers, and care-seeking barriers and enablers.

High maternal mortality in Jigawa State, Northern Nigeria estimated using the sisterhood method.

Background: Maternal mortality is extremely high in Nigeria. Accurate estimation of maternal mortality is challenging in low-income settings such as Nigeria where vital registration is incomplete. The objective of this study was to estimate the lifetime risk (LTR) of maternal death and the maternal mortality ratio (MMR) in Jigawa State, Northern Nigeria using the Sisterhood Method.