Addressing social factors of adolescent reproductive health in the Republic of Georgia.

The influence of social factors on reproductive health has been highlighted by researchers in the last decade, yet programmes to improve adolescent reproductive health (ARH) rarely address social factors such as gender discrimination. Beginning in 2004, CARE International implemented and evaluated a three-year ARH project to address individual behaviour change, institutional capacity and local social norms related to ARH in a rural district of the Republic of Georgia. Community engagement strategies included: promoting community support for ARH by adolescent/adult volunteer change agents; building health providers' capacity to better meet the needs of adolescents; and using 'Theatre for Development' to promote community dialogue about social norms. Project evaluation data demonstrated improved knowledge, attitudes, behaviour about family planning, improved institutional capacity to provide adolescent services and some evidence of shifts in gender norms. Community engagement is critical for successful strategies to influence social norms that promote healthy reproductive health.

Making EmOC a reality--CARE's experiences in areas of high maternal mortality in Africa.

OBJECTIVE: This paper describes the package of interventions undertaken by the CARE/AMDD program collaboration to increase the availability and quality of emergency obstetric care for 3 high maternal mortality countries in Africa. METHODS: Project implementation over 4 years focused on enhancing the capacity of 10 district hospitals in 3 countries - Tanzania, Rwanda and Ethiopia. Interventions were designed to create functional health facilities with trained and competent staff, working in an enabling environment supporting EmOC service delivery. RESULTS: By keeping a clear focus on EmOC, the project achieved modest improvements in services, even in the face of the considerable constraints of rural district hospitals. Availability and utilization of EmOC increased in Tanzania; the met need for EmOC increased slightly from 14% in year 1 to 19% in year 4, while in Rwanda it increased from 16% to 25% over 4 years. Case fatality rates (CFR) declined by 30-50% in all 3 countries. While still well below UN recommendations, in all 3 countries there was also a progressive increase in the cesarean section rates, a life saving obstetric intervention. CONCLUSIONS: The increases in met need and decreases in case fatality suggest that project interventions improved the quality and use of EmOC, a critical component for saving women's lives.

Implementing a malaria curtains project in rural Malawi.

This paper describes planning, implementation, monitoring and evaluation activities carried out in support of a malaria control project that used permethrin-impregnated curtains in eight villages in rural Malawi. Findings from formative evaluation and project monitoring aspects of the evaluation are presented. Permethrin-impregnated curtains were introduced to villagers who participated in household self-help projects. To implement the project, village health workers were trained and worked closely with existing project personnel as well as traditional headmen to assure village participation, facilitate health education and coordinate curtain-dipping (impregnation) meetings. A quasi-experimental evaluation design used surveys and observations to measure change in cognitive, behavioural and health outcome indicators. Village adoption rates averaged 50%, with variation between villages. Monitoring data showed a high degree of compliance with curtain re-impregnation initially and high perceived efficacy of curtains. Issues discussed include village readiness for change, trust, acceptability of the innovation, cost, sustainability and leadership.

PIP: Many malaria prevention strategies in sub-Saharan Africa promote household preventive sanitation self-help activities. However, it has been shown to have limited effectiveness, as well as increased parasite resistance to anti-malarial drugs, or unacceptable levels of toxicity in environmental spraying. This paper reports on planning, implementation, monitoring of an impregnated curtain project in rural Malawi. In this intervention, permethrin-impregnated curtains were introduced to villagers who participated in household self-help projects. To implement the project, village health workers were trained and worked closely with existing project personnel, as well as traditional headmen to assure village participation, facilitate health education and coordinate curtain-dipping (impregnation) meetings. A quasi-experimental evaluation design used surveys and observations to measure change in cognitive, behavioral and health outcome indicators. Village adoption rates averaged 50%, with variation between villages. Monitoring data showed a high degree of compliance with curtain re-impregnation initially and high perceived efficacy of curtains. Other issues discussed include village readiness for change, trust, and acceptability of the innovation, cost, sustainability, and leadership.