Youth accessing reproductive health services in Malawi: drivers, barriers, and suggestions from the perspectives of youth and parents.

BACKGROUND: Malawi has made progress in increasing its overall modern contraceptive prevalence rate since 2000, resulting in a dramatic reduction in its total fertility rate. However, youth, 15-24 years, have not had the same successes. Teenage pregnancies are on the rise and little progress has been made in reducing unmet need for family planning among youth. With two-thirds of the population under the age of 25 and with Malawi's rapid population growth, reducing unmet need for family planning among youth remains a priority for the government's reproductive health agenda. To further explore this situation, we conducted a qualitative study to explore the perspectives of youth and adults about the drivers and barriers to youth accessing family planning in Malawi and their ideas to improve services. METHODS: We conducted 34 focus group discussions with youth aged 15-24 and parents or legal guardians of female youth in 3 districts in Malawi. Focus groups were translated and transcribed. Data was input into Dedoose and analyzed using a thematic framework to identify broader patterns and themes. RESULTS: Youth participants felt motivated to use family planning to protect themselves from sexually transmitted diseases and to prevent unwanted pregnancies. Females focused on the consequences of unplanned pregnancies and believed family planning services were targeted primarily at them, while males thought family planning services targeted males and females equally. Barriers to youth accessing family planning included contraception misconceptions, the costs of family planning services, and negative attitudes. Parents had mixed views on family planning. While many parents acknowledged they could play a role in supporting youth, most said they are reluctant to support youth using family planning. Participants said improving counseling services, integrating family planning services and education within school curricula, and utilizing youth clubs could improve family planning services for youth. CONCLUSIONS: Policy makers and program implementers should consider the diverse preferences among youth and parents and continue seeking their input when designing policies and programs. Youth clubs and school-based services were among the most common suggestions. However, the effectiveness of youth clubs and school-based initiatives to increase contraceptive use among youth in Malawi is not clear.

How is the Lives Saved Tool (LiST) used in the global health community? Results of a mixed-methods LiST user study.

BACKGROUND: The Lives Saved Tool (LiST) is a computer-based model that estimates the impact of scaling up key interventions to improve maternal, newborn and child health. Initially developed to inform the Lancet Child Survival Series of 2003, the functionality and scope of LiST have been expanded greatly over the past 10 years. This study sought to "take stock" of how LiST is now being used and for what purposes. METHODS: We conducted a quantitative survey of LiST users, qualitative interviews with a smaller sample of LiST users and members of the LiST team at Johns Hopkins University, and a literature review of studies involving LiST analyses. RESULTS: LiST is being used by donors, international organizations, governments, NGOs and academic institutions to assist program evaluation, inform strategic planning and evidenced-based decision-making, and advocate for high-impact interventions. Some organizations have integrated LiST into internal workflows and built in-house capacity for using LiST, while other organizations rely on the LiST team for support and to outsource analyses. In addition to being a popular stand-alone software, LiST is used as a calculation engine for other applications. CONCLUSIONS: The Lives Saved Tool has been reported to be a useful model in maternal, newborn, and child health. With continued commitment, LiST should remain as a part of the international health toolkit used to assess maternal, newborn and child health programs.

All things to all people: trade-offs in pursuit of an ideal modeling tool for maternal and child health.

BACKGROUND: Modeling tools have potential to aid decision making for program planning and evaluation at all levels, but are still largely the domain of technical experts, consultants, and global-level staff. One model that can improve decision making for maternal and child health is the Lives Saved Tool (LiST). We examined respondents' perceptions of LiST's strengths and weaknesses, to identify ways in which LiST - and similar modeling tools - can adapt to be more accessible and helpful to policy makers. METHODS: We interviewed 21 purposefully sampled LiST users. First, we identified the characteristics that respondents explicitly stated, or implicitly implied, were important in a modeling tool, and then used these results to create a framework for reviewing a modeling tool. Second, we used this framework to categorize the strengths and weaknesses of LiST that respondents articulated. RESULTS: Two overarching qualities were important to respondents: usability and accuracy. For some users, LiST already meets these criteria: it allows for customized input parameters to increase specificity; the interface is intuitive; the assumptions and calculations are scientifically sound; and the standard metric of "additional lives saved" is understood and comparable across settings. Other respondents had different views, although their complaints were typically not that the tool is unusable or inaccurate, but that aspects of the tool could be better explained or easier to understand. CONCLUSION: Government and agency staff at all levels should be empowered to use the data available to them, including the use of models to make full use of these data. For this, we need tools that meet a threshold of both accuracy, so results clarify rather than mislead, and usability, so tools can be used readily and widely, not just by select experts. With these ideals in mind, there are ways in which LiST might continue to be improved or adapted to further advance its uptake and impact.

Discovery of a series of imidazopyrazine small molecule inhibitors of the kinase MAPKAPK5, that show activity using in vitro and in vivo models of rheumatoid arthritis.

MAPKAPK5 has been proposed to play a role in regulation of matrix metalloprotease expression and so to be a potential target for intervention in rheumatoid arthritis. We present here the identification of a series of compounds against this target which are effective in both biochemical and cell assays. The expansion of the series is described, along with early SAR and pharmacokinetics for some representative compounds.