Suchergebnisse

SummaryA job aid is a tool, such as a flowchart or checklist, that makes it easier for staff to carry out tasks by providing quick access to needed information. Many public health organizations are engaged in the production of job aids intended to improve adherence to important medical guidelines and protocols, particularly in resource-constrained countries. However, some evidence suggests that actual use of job aids remains low. One strategy for improving utilization is the introduction of job aids in training workshops. This paper summarizes the results of two separate evaluations conducted in Uganda and the Dominican Republic (DR) which measured the usefulness of a series of four family planning checklists 7–24 months after distribution in training workshops. While more than half of the health care providers used the checklists at least once, utilization rates were sub-optimal. However, the vast majority of those providers who utilized the checklists found them to be very useful in their work.

SummaryIn order to determine the validity of infant mortality estimates based on retrospective reporting, the Honduran Ministry of Health carried out a follow-up survey of women interviewed in a 1987 national survey. Women were interviewed approximately 14 months after the baseline survey and were asked about the outcomes of their pregnancies and the survival status of their young children. The overall infant mortality rate calculated from the follow-up survey was lower than that obtained from the baseline survey, due to the particularly low rate among the group of women who were pregnant at the time of the baseline survey. Possible explanations for this low rate are discussed.

IntroductionSimultaneous use of contraceptive hormones and anti‐retroviral therapy (ART) may theoretically lessen the effectiveness of both. Women on ART need assurance that hormonal contraception is safe and effective. The sub‐dermal implant is an ideal product to study: low and steady progestin release and no adherence uncertainties. We sought to determine if the medications' effectiveness is compromised.MethodsWe conducted a prospective cohort study among women on first line ART (stavudine or zidovudine and lamivudine+nevirapine). We recruited new implant users and matched them to women not using hormonal contraception, based on age and baseline CD4. Participants were followed prospectively for up to two years, recording serial CD4 measures and medical histories. We used generalized growth curve models and Wald chi‐square tests to compare changes in CD4 counts across study groups. Prospective CD4 measures were censored (excluded) if any of the following events occurred: change in ART, implant removal or use of any hormonal contraception among controls. We examined incidence of opportunistic infection and pregnancy.ResultsWe matched 48 implant users to 33 non‐hormonal controls. Over time, CD4 counts for both groups rose slightly but did not deviate significantly from each other (p=0.44). Opportunistic infection rates did not differ between the groups. None of the implant users and one of the non‐hormonal controls became pregnant during follow‐up.ConclusionsThis small study found concurrent use of contraceptive implants and ART to be safe and effective. Although other hormonal contraceptive products and ART regimens may interact in unknown ways, the results of this study are reassuring.