Journal Articles

JSI staff regularly publish their research and results from work in peer-reviewed journals. This section provides a brief abstract with a link to the journal where you can read more and either download or order the article, depending on the journal.

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Rapid Assessment of Ebola-Related Implications for Reproductive, Maternal, Newborn and Child Health Service Delivery and Utilization in Guinea in PLOS One

Guinea was ground zero for the 2014 outbreak of Ebola virus, and health experts were concerned that other critical health issues such as routine care for maternal and child health, might suffer because of clinic closures or fears of contracting the virus. MEASURE Evaluation conducted a rapid assessment to understand better the effects of Ebola and published a journal article on the results, authored by Janine Barden O’Fallon, Alimou Barry, Paul Brodish, and Jack Hazerjian.

Read the full article at PLOS | Current Outbreaks.

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October 2015

Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana in Human Resources for Health, Vol. 13

A strong health system requires a competent and caring workforce. Satisfied and Motivated health workforces are more willing to serve in difficult areas, have lower turnover, and theoretically provide better care to patients. This study, conducted as part of the Innovations for MNCH Initiative, examines the motivation, satisfaction, and correlation with clinical knowledge, of community health nurses (CHNs), a cadre of provider focused on maternal, newborn and child health in rural Ghana.

Authors: Emma Sacks, Soumya Alva, Sophia Magalona, Linda Vesel

Read the abstract or download the full article

Changes in equity of maternal, newborn, and child health care practices in 115 districts of rural Ethiopia: implications for the health extension program in BioMed Central Pregnancy and Childbirth, Volume 15

The Last Ten Kilometers Project (L10K) supports the HEP in promoting equitable MNCH interventions in 115 districts covering about 14 million people in Ethiopia. The project reported the inequities in MNCH programmatic indicators in 2008 and in 2010 in the L10K areas, along with changes in equity between the two survey periods, and the implications of these results for the national program.

The study used cross-sectional surveys of 3932 and 3867 women from 129 representative kebeles (communities) conducted in December 2008 and December 2010, respectively. Nineteen HEP outreach activity coverage and MNCH care practice indicators were calculated for each survey period, stratified by the inequity factors considered (i.e. age, education, wealth and distance from the nearest health facility).

Authors: Ali Mehryar Karim, Addis Tamire, Araya Abrha Medhanyie and Wuleta Betemariam

Access the full article at BioMed Central Pregnancy and Childbirth

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September 2015

Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries in Health Policy and Planning

The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Harvard Medical School researchers and JSI's Brian Serumaga conducted a study to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access.

Download the article at Health Policy and Planning.

Authors: Vialle-Valentin, Catherine, Serumaga, Brian, Wagner, Anita, Ross-Degnan, Dennis

Task Shifting Provision of Contraceptive Implants to Community Health Extension Workers: Results of Operations Research in Northern Nigeria in Global Health: Science and Practice, September 2015, vol.3 Number 3

Contraceptive use remains low in Nigeria, with only 11% of women reporting use of any modern method. Access to long-acting reversible contraceptives (LARCs) is constrained by a severe shortage of human resources. To assess feasibility of task shifting provision of implants, TSHIP trained community health extension workers (CHEWs) to insert and remove contraceptive implants in rural communities of Bauchi and Sokoto states in northern Nigeria.

To assess feasibility of the task shifting approach, TSHIP conducted operations research using a retest–post test design using multiple sources of information, including surveys with 151 trained CHEWs (9% were lost to follow-up) and with 150 family planning clients; facility observations using supply checklists (N=149); direct observation of counseling provided by CHEWs (N=144) and of their clinical (N=113) skills; as well as a review of service statistics (N=151 health facilities). The endline assessment was conducted 6 months after the training in each state.

View the full article at Global Health Science and Practice.

Count every newborn; a measurement improvement roadmap for coverage data in BMC Journal of Pregnancy and Childbirth, vol. 15, supplement 2

Globally, newborn deaths account for at least 44% of all deaths of children under the age of five. Launched in 2014, the Every Newborn Action Plan, developed by a consortium of international aid foundations, government agencies, academic institutions, and NGOs, provides a road map for ending preventable newborn deaths and stillbirths. The Every Newborn movement focuses on three streams of work to achieve its objectives: 1) Country Advocacy, 2) Advocacy, and 3) Data Metrics.

For this study, published in the BMC journal Pregnancy and Childbirth's special Every Woman, Every Newborn supplement, researchers developed a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work.

Authors: Sarah G Moxon; Harriet Ruysen; Kate J Kerber; Agbessi Amouzou; Suzanne Fournier; John Grove; Allisyn C Moran; Lara ME Vaz; Hannah Blencowe; Niall Conroy; A Metin Gülmezoglu; Joshua P Vogel; Barbara Rawlins; Rubayet Sayed; Kathleen Hill; Donna Vivio; Shamim A Qazi; Deborah Sitrin; Anna C Seale; Steve Wall; Troy Jacobs; Juan Gabriel Ruiz Peláez; Tanya Guenther; Patricia S Coffey; Penny Dawson; Tanya Marchant; Peter Waiswa; Ashok Deorari; Christabel Enweronu-Laryea; Shams El Arifeen; Anne CC Lee; Matthews Mathai; and Joy E Lawn

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July 2015

A Report of At-Scale Distribution of Chlorhexidine Digluconate 7.1% Gel for Newborn Cord Care to 36,404 Newborns in Sokoto State, Nigeria: Initial Lessons Learned in PLoS ONE, 10(7) July 30, 2015 DOI: 10.1371/journal.pone.0134040

With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of any country in the world. Global progress in accelerating neonatal deaths is hinged to scaled-up interventions in Nigeria. Routine data of chlorhexidine digluconate 7.1% gel utilized by 36,404 newborns delivered by 36,370 mothers, was use to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria.

Enhancements in the predictable availability and supply of chlorhexidine digluconate 7.1% gel to communities through better, evidence-based logistics management by the state public sector will most likely dramatically increase program scalability. Infections as a cause of mortality in babies delivered in home settings may be much higher than previously conceived. In tandem with high prevalence of stillborn deaths, delivery, interventions designed to increase mothers’ timely and regular use of quality antenatal care, and increased facility-based based delivery, need urgent attention. We call for accelerated investments in community health volunteer programs and the requisite community measurement systems to better track coverage. We also advocate for the development, refinement and use of routine community-based verbal autopsies to track newborn and maternal survival.

Authors: Nosakhare Orobaton , Dele Abegunde, Kamil Shoretire, Jumare Abdulazeez, Bolaji Fapohunda, Goli Lamiri, Abubakar Maishanu, Akeem Ganiyu, Eric Ndifon, Ringpon Gwamzhi, Matthew Osborne-Smith (2015)

Can the health system deliver? Determinants of rural Liberians’ confidence in health care in Health Policy and Planning

Following a protracted civil war, Liberia is rebuilding its health system and expanding access to health care to previously underserved rural populations. Researchers, including JSI's Rose Jallah Macauley, analyzed the determinants of Liberians' confidence in their ability to obtain health services in the case of serious illness. The study surveyed 1435 adults in rural Nimba County, and logistic regression models were estimated with reported ability to obtain health services for serious illness as the dependent variable, and demographics, health need, health system characteristics and informal health care as independent variables.

Download the full article at the Journal of Health Policy and Planning

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June 2015

Successful Proof of Concept of Family Planning and Immunization Integration in Liberia in Global Health: Science and Practice, June 2015, Volume 3, Issue 2.

Globally, unmet need for postpartum family planning remains high, while immunization services are among the most wide reaching and equitable interventions. Given overlapping time frames, integrating these services provides an opportunity to leverage existing health visits to offer women more comprehensive services. From March through November 2012, Liberia’s government, with support from the Maternal and Child Health Integrated Program (MCHIP), piloted an integrated family planning and immunization model at 10 health facilities in Bong and Lofa counties. Vaccinators provided mothers bringing infants for routine immunization with targeted family planning and immunization messages and same-day referrals to co-located family planning services.

In February 2013, we compared service statistics for family planning and immunization during the pilot against the previous year’s statistics. We also conducted in-depth interviews with service providers and other personnel and focus group discussions with clients. However, results suggest that introducing a simple model that is minimally disruptive to existing immunization service delivery can facilitate integration. The model is currently being scaled-up to other counties in Liberia, which could potentially contribute to increased postpartum contraceptive uptake, leading to longer birth intervals and improved health outcomes for children and mothers. By Chelsea M Coopera, JSI's Rebecca Fields, Corinne I Mazzeoc, Nyapu Taylord, Anne Pfitzera, Mary Momolue, Cuallau Jabbeh-Howee.

Factors influencing the use of magnesium sulphate in pre-eclampsia/eclampsia management in health facilities in Northern Nigeria: a mixed methods study in BMC Pregnancy & Childbirth, Volume 15

Eclampsia remains a major cause of perinatal and maternal morbidity and mortality worldwide. Researchers from the JSI-managed Targeted States High Impact Project (TSHIP) collected data from 80 health facilities in Northern Nigeria's Bauchi and Sokoto states to examine facilitators and barriers to the use of magnesium sulphate in the management of pre-eclampsia/eclampsia. Research methods and results are presented in the full article, available at BMC Pregnancy & Childbirth.

Authors: Olugbenga Oguntunde, Zulfiya Charyeva, Molly Cannon, William Sambisa, Nosakhare Orobaton, Ibrahim A Kabo, Kamil Shoretire, Saba’atu E Danladi, Nurudeen Lawal, and Habib Sadauki.

Marine protected areas and children’s dietary diversity in the Philippines in Population and Environment, Journal No. 11111

Fish living around the coral reefs in the Philippines provide livelihoods for more than a million local fishers and are an important source of protein for coastal communities. However, this rich resource is at risk from myriad threats, which consequently threaten human livelihoods, nutrition, and health. In this paper, we examine the degree to which marine protected areas (MPAs), which aim to conserve marine biodiversity, are associated with improved nutritional outcomes in children under age 5. This analysis, which uses data from the 2008 Philippines Demographic and Health Survey and MPA data from the Coastal Conservation and Education Fund, found a positive association between MPAs and children’s dietary diversity when the MPAs were located closer than 2 km to a child’s community. MPA characteristics such as age or type of management were not consistently associated with dietary diversity. These results suggest a positive association of proximity to MPAs with certain aspects of children’s diet.

Authors: Soumya Alva, Kiersten Johnson, Anila Jacob, Heather D’Agnes, Richard Mantovani, Thea Evans.

Institutionalizing early vaccination of newborns delivered at government health facilities: Experiences from India in International Journal of Medical Research and Review, Volume 3, Issue 5

Newborn vaccination is identified as a critical parameter for evaluating the overall performance of immunization programs with guidelines clearly advocating for administration of BCG, OPV zero dose and Hepatitis B birth dose to newborns. In spite of sustained improvement in full immunization coverage in India, coverage of newborn vaccines has remained traditionally low. The USAID-supported Maternal and Child Health Integrated Program (MCHIP), operational in India from 2009 – 2014 provided technical support to the Universal Immunization Program (UIP) at the national level and in the states of Jharkhand and Uttar Pradesh. During the project period, MCHIP undertook an assessment in 46 selected health facilities across 5 districts of the two states to study the implementation of the newborn vaccination program.

Key findings included a lack of knowledge among staff about the benefits of newborn vaccination, absence of written guidelines, unavailability of one vaccine compromising the administration of the remaining two and poor documentation practices. Following the assessment, technical support was provided to strengthen implementation at these selected facilities. The intervention produced favorable results with a progressive increase in coverage of not only BCG and OPV zero dose but also Hepatitis B birth dose which was introduced in the UIP during the course of the intervention.

Overall this intervention, which focused on operationalizing an already existing strategy, clearly indicated that the practice of vaccinating newborns delivered at health facilities is easily implementable and replicable, and that its sustainability should ensure improved coverage and protection against targeted vaccine-preventable diseases. Authors: G Taneja, VK Mentey, M Jain, KS Sagar, B Tripathi, Michael Favin, Robert Steinglass.

Strategies for Coordination of a Serosurvey in Parallel with an Immunization Coverage Survey in The American Society of Tropical Medicine and Hygiene, Volume 92 (6)

A community-based immunization coverage survey is the standard way to estimate effective vaccination delivery to a target population in a region. Accompanying serosurveys can provide objective measures of protective immunity against vaccine-preventable diseases but pose considerable challenges with respect to specimen collection and preservation and community compliance. Serosurveys were performed coupled to immunization coverage surveys in three administrative districts (woredas) in rural Ethiopia. Critical to the success of this effort were serosurvey equipment and supplies, team composition, and tight coordination with the coverage survey. Application of these techniques to future studies may foster more widespread use of serosurveys to derive more objective assessments of vaccine-derived seroprotection and monitor and compare the performance of immunization services in different districts of a country.

Authors: Mark A. Travassos, Center for Vaccine Development, University of Maryland School of Medicine, Berhane Beyene, Zenaw Adam, James D. Campbell, Nigisti Mulholland, Seydou S. Diarra, Tassew Kassa, Lisa Oot, Jenny Sequeira, Mardi Reymann, William C. Blackwelder, Marcela F. Pasetti, Samba O. Sow, Robert Steinglass, Amha Kebede, and Myron M. Levine.

Countdown to 2015: Tracking Maternal and Child Health Intervention Targets Using Lot Quality Assurance Sampling in Bauchi State Nigeria in PLoS ONE, Volume 10

Improving maternal and child health remains a top priority in Nigeria’s Bauchi State in the northeastern region where the maternal mortality ratio (MMR) and infant mortality rate (IMR)are as high as 1540 per 100,000 live births and 78 per 1,000 live births respectively. This study used the framework of the continuum of maternal and child care to evaluate the impact of interventions in Bauchi State focused on improved maternal and child health, and to ascertain progress towards the achievement of Millennium Development Goals (MDGs) 4 and 5.

Women residents in the households were interviewed about their own health and that of their children. Estimated LGA coverage of maternal and child health indicators were aggregated across the State. These values were then compared to the national figures, and the differences from 2012 to 2014 were calculated. For several of the indicators, a modest improvement from baseline was found. However, the indicators in the continuum of care neither reached the national average nor attained the 90% globally recommended coverage level.

Intensive scale-up of programs and interventions is needed in Bauchi State, Northern Nigeria, to accelerate, consolidate and sustain the modest but significant achievements in the continuum of care, if MDGs 4 and 5 are to be achieved by the end of 2015. The intentional focus of LGAs as the unit of intervention ought to be considered a condition precedent for future investments. Priority should be given to the re-allocating resources to program areas and regions where coverage has been low. Finally, systematic considerations need to be given to the design of strategies that address the demand for health services.

RED for PMTCT: An adaptation of immunization's Reaching Every District approach increases coverage, access, and utilization of PMTCT care in Bondo District, Kenya in International Journal of Gynecology and Obstetrics, Volume 130, Supplement 2, S68–S73

Gaps exist in coverage, early access, and utilization of prevention of mother-to-child transmission of HIV (PMTCT) services in Kenya. The Maternal and Child Health Integrated Program piloted an adaptation of immunization’s Reaching Every District (RED) approach in Bondo District as a way of improving PMTCT care. Routine district-level monthly summary service delivery pre- and post-implementation data were analyzed.

Marked improvements resulted in the proportion of HIV-infected and non-infected pregnant women completing four focused prenatal care visits, from 25% to 41%, and the proportion of HIV-exposed infants (HEIs) tested at six weeks, from 27% to 78% (P b 0.001). The proportion of HEIs tested for HIV infection at 12 months was 52%, while 77% of HEIs were issued antiretroviral prophylaxis by the end of the pilot. Implementation of RED for PMTCT demonstrated that PMTCT services can be delivered effectively in the context of the existing community strategy and resulted in increased coverage, access, and utilization of care for HIV-positive pregnant women and their children. Authors, Lynn Kanyuuru (Jhpiego), Mark Kabue (Jhpiego), Tigistu A. Ashengo (Jhpiego), Chandrakant Ruparelia (Jhpiego), Evans Mokaya (JSI), Isaac Malonza (Jhpiego).

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May 2015

Reducing the burden of diarrhea among children under five years old: Lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria in Journal of Health, Population, and Nutrition

Oral rehydration theraphy (ORT) corners were introduced at health facilities in the Northern Nigerian states of Bauchi and Sokoto to treat sick children and equip caregivers with skills in case management of diarrhea and diarrhea prevention. Researches from the Targeted States High Impact (TSHIP) project, including Olugbenga Oguntunde, Amos Paul Bassi, Mohammed Auwal Ibrahim, Saba'atu Danladi, William Sambisa, and Nurudeen Lawal, studied the effect of facility-based ORT corners on caregivers' knowledge and case management skills and examined whether ORT activities were conducted according to protocol.

Study results showed that ORT corner users were more knowledgeable in diarrhea prevention and management and demonstrated better skills for managing diarrhea than ORT corner non-users. The research methods, findings, and recommendations have been published in the May 2015 issue of the Journal of Health, Population, and Nutrition.

Iron+folic acid distribution and consumption through antenatal care: identifying barriers across countries in Journal of Public Health Nutrition

The prevalence of maternal anemia remains unacceptably high in developing countries. At the same time, the percentage of women who consume one or more Fe+folic acid (IFA) tablets during pregnancy remains persistently low. The objective of this study, conducted by researchers from the SPRING project, including JSI's Alexis D'Agostino, was to identify where, within antenatal care (ANC) programs, pregnant women falter in obtaining and consuming an ideal minimum of 180 IFA tablets.

View the abstract and download the full article at the Journal of Public Health Nutrition

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April 2015

The gas cylinder, the motorcycle and the village health team member: a proof-of-concept study for the use of the Microsystems Quality Improvement Approach to strengthen the routine immunization system in Uganda in Implementation Science, Volume 10

The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative assessed the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems in Masaka District, Uganda. Assessment was made through quantitative and qualitative methods and found that barriers to routine immunization, including lack of back up gas cylinders at facilities, inadequate transportation, and underutilized village health teams, were successfully addressed through the Microsystems Quality Improvement Approach. JSI's Lea Ayers LaFave co-authored the article based on the ARISE-SI assessment with researchers from the Darmouth Institute for Health Policy and Clinical Practice, Dartmouth's Geisel School of Medicine, Loma Linda University School of Medicine and the Makerere University School of Public Health.

Read the full article at Implementation Science

Trends in childbirth with no one present in Nigeria between 2003 and 2013 in International Journal of Women's Health, Vol. 7

Nigeria has one of the highest maternal mortality rates in the world. Contributing to this statistic is the high percentage of births that take place at home without the presence of a skilled birth attendant. Researchers, including JSI's Bolaji Fapohunda and Nosa Orobaton, examined pooled data sets from the 2003, 2008, and 2013 Nigerian Demographic and Health Surveys to document trends in women delivering at home with no one present and identify unifying characteristics of these women.

Study results indicated that delivery with no one present declined by 30% overall between 2003 and 2013, however there was a 27% increase in births with no one present in Nigeria's North West region. Age, income, and religious practices also emerged as factors in determining the likelihood that a woman would deliver at home with no one present. Findings also suggest a stagnation in the decline of unattended births in Nigeria; researchers call for the implementation of interventions to ensure timely access to and use of skilled obstetric care to reduce maternal mortality and morbidity.

Read the full article at International Journal of Women's Health

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March 2015

The Effect of Access to Contraceptive Services on Injectable Use and Demand for Family Planning in Malawi in International Perspectives on Sexual and Reproductive Health

One of the most direct ways to reduce maternal mortality rates in developing countries is to address unmet need for contraception - that is, enable women who want to avoid or delay pregnancy to access modern family planning methods. Understanding the barriers to this access is therefore critical to reducing maternal mortality.

To better understand these barriers, JSI staff from the USAID | DELIVER PROJECT and members of the MEASURE Evaluation team looked at what modern mapping software and logistics data reveal about how women in Malawi respond to the availability of contraceptive services in their local environment.

Transactional Sex Among Men Who Have Sex With Men in Latin America: Economic, Sociodemographic, and Psychosocial Factors in American Journal of Public Health

Researchers, including JSI's Stewart Landers (Director of JSI Health Services, Boston) assessed factors associated with engagement in transactional sex among men who have sex with men recruited from one of the largest internet sites for men seeking social or sexual interaction with other men in Latin America. Factors were analyzed by way of multilevel regression models in 17 Latin American Countries. Research findings showed that higher country-level unemployment was associated with increased odds of transactional sex. A correlation between interpersonal or individual factors, such as self-reported HIv or sexually transmitted infection, intimate partner violence, and sexual compulsivity, and elevated odds of engagement in transactional sex was also found.

Engaging Communities With a Simple Tool to Help Increase Immunization Coverage in Global Health: Policy and Practice

The level of vaccination coverage in a given community depends on both service factors and the degree to which the public understands and trusts the immunization process. This article describes an approach that aims to raise awareness and boost demand. Developed in India, the “My Village Is My Home” (MVMH) tool, known as Uma Imunizasaun (UI) in Timor-Leste, is a poster-sized material used by volunteers and health workers to record the births and vaccination dates of every infant in a community. Introduction of the tool in 5 districts of India and in 7 initial villages in Timor-Leste allowed community leaders, volunteers, and health workers to monitor the vaccination status of every young child and guided reminder and motivational visits.

In India, pilot communities had 80% or higher coverage of identified and eligible children for all vaccines. In comparison, overall coverage in the respective districts during the same time period was much lower, at 49% to 69%. In Timor-Leste, both the number of infants identified and immunized rose substantially with use of the tool compared with the previous year. The experiences in both countries suggest that “My Village Is My Home” is a promising tool that has the potential to broaden program coverage by marshalling both community residents and health workers to track individual children's vaccinations. Three states in India have adopted the tool, and Timor-Leste had also planned to scale-up the initiative.

Glob Health Sci Pract 2015;3(1):117-125.

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February 2015

Mental health of youth orphaned due to AIDS in South Africa: biological and supportive links to caregivers in Vulnerable Children and Youth Studies: An International Interdisciplinary Journal for Research, Policy and Care

In South Africa, over two million children have lost at least one parent to HIV. Youth who are orphaned by the AIDS epidemic have significantly higher levels of depression, anxiety, and post-traumatic stress than non-orphaned youth, or orphans whose parents died from other causes.

Researchers, including JSI's Melissa Sharer, explored the biological and social support relationship between youth orphaned by HIV/AIDS and their caregivers to identify factors related to positive mental health outcomes. 254 orphaned youths were selected from a 2009 cross-sectional survey to examine caregiver relationships and their affect on the mental health of the youth. Download the full article for research methodology and findings.

Maternal Characteristics and Clinical Diagnoses Influence Obstetrical Outcomes in Indonesia in Maternal Child Health Journal, (2015) 19:1624-1633.

This Indonesian study evaluates associations between near-miss status/death with maternal demographic, health care characteristics, and obstetrical complications, comparing results using retrospective and prospective data. The main outcome measures were obstetric conditions and socioeconomic factors to predict near-miss/death.

Associations with near-miss/death were seen for antepartum hemorrhage in retrospective data, and prospectively for poverty and delivering outside the hospital. Postpartum hemorrhage and severe preeclampsia/eclampsia are leading causes of near-miss/death in Indonesia. Poverty and delivery outside the hospital are significant risk factors. Prompt recognition of complications, timely referrals, standardized care protocols, prompt hospital triage, and structured provider education may reduce obstetric mortality and morbidity. Retrospective data were reliable, but prospective data provided valuable information about barriers to care and referral patterns.

Authors: Asri Adisasmita, Carl V. Smith, Ayman A. E. El-Mohandes, Poppy Elvira Deviany, Judith J. Ryon, Michele Kiely, Quail Rogers-Bloch, Reginald F. Gipson

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