Intersecting inequalities, gender and adolescent health in Ethiopia.

BACKGROUND: Until recently, global public health initiatives have tended to overlook the ways that social factors shape adolescent health, and particularly how these dynamics affect the specific needs of adolescents in relation to information about puberty, menstruation and sexual health. This article draws on mixed methods data from rural and urban areas of Ethiopia to explore how access to health information and resources - and subsequently health outcomes - for adolescents are mediated by gender and age norms, living in different geographical locations, poverty, disability and migration. METHODS: Data was collected in 2017-2018 for the Gender and Adolescence: Global Evidence (GAGE) mixed-methods longitudinal research baseline in three regions of Ethiopia (Afar, Amhara and Oromia). Quantitative data was collected from over 6800 adolescents and their caregivers, with qualitative data obtained from a sub-sample of 220 adolescents, their families and communities. Adolescent participants shared their experiences of health, illness and nutrition over the previous year; their knowledge and sources of information about sexual and reproductive health and puberty; and their attitudes toward sexual and reproductive health. Regression analysis was used to explore differences by gender, age, rural/urban residence, and disability status, across a set of adolescents' health knowledge and other outcomes in the quantitative data. Intersectional analysis was used in analysing the qualitative data. RESULTS: Analysis suggested that gender inequality intersects with age, disability and rural/urban differences to shape young people's access to information about puberty, with knowledge about this topic particularly lacking amongst younger adolescents in rural areas. Drought and lack of access to clean water exacerbates health challenges for adolescents in rural areas, where a lack of information and absence of access to preventive healthcare services can lead to permanent disability. The research also found that gaps in both school-based and alternative sources of education about puberty and menstruation reinforce stigma and misinformation, especially in rural areas where adolescents have higher school attrition rates. Gendered cultural norms that place high value on marriage and motherhood generate barriers to contraceptive use, particularly in certain rural communities. CONCLUSIONS: As they progress through adolescence, young people's overall health and access to information about their changing bodies is heavily shaped by intersecting social identities. Structural disadvantages such as poverty, distress migration and differential access to healthcare intersect with gender norms to generate further inequalities in adolescent girls' and boys' health outcomes.

Do restrictive gender attitudes and norms influence physical and mental health during very young Adolescence? Evidence from Bangladesh and Ethiopia.

Adolescence is seen as a window of opportunity for intervention but also as a time during which restrictive gender attitudes and norms become more salient. This increasingly gendered world has the potential to profoundly influence adolescents' capabilities, including their physical and mental health. Using quantitative data on 6,500 young adolescents (10-12) from the Gender and Adolescence: Global Evidence (GAGE) program, this paper analyses the association between restrictive gender attitudes (RGAs) at the individual level and restrictive gender norms (RGNs) at the community level and physical and mental health in Bangladesh and Ethiopia. We find significant associations between RGAs and RGNs and height-for-age z-scores, body mass index z-scores, self-reported health, adolescent hunger, psychological well-being, and self-esteem. We find no relationship between RGAs or RGNs and illness. We also find heterogeneity across country and urbanicity. We find surprisingly limited variation by gender, and the differences we do see point to important vulnerabilities for both boys and girls. Our results point to the powerful role that distal factors such as culture and beliefs, as manifested through RGAs and RGNs, can play in shaping health outcomes for both boys and girls and suggest important next steps for future research and policy.

Worms at Work: Long-run Impacts of a Child Health Investment.

This study estimates long-run impacts of a child health investment, exploiting community-wide experimental variation in school-based deworming. The program increased labor supply among men and education among women, with accompanying shifts in labor market specialization. Ten years after deworming treatment, men who were eligible as boys stay enrolled for more years of primary school, work 17% more hours each week, spend more time in nonagricultural self-employment, are more likely to hold manufacturing jobs, and miss one fewer meal per week. Women who were in treatment schools as girls are approximately one quarter more likely to have attended secondary school, halving the gender gap. They reallocate time from traditional agriculture into cash crops and nonagricultural self-employment. We estimate a conservative annualized financial internal rate of return to deworming of 32%, and show that mass deworming may generate more in future government revenue than it costs in subsidies.

The Case for Mass Treatment of Intestinal Helminths in Endemic Areas.

Two articles published earlier this year in the International Journal of Epidemiology [1,2] have re-ignited the debate over the World Health Organization's long-held recommendation of mass-treatment of intestinal helminths in endemic areas. In this note, we discuss the content and relevance of these articles to the policy debate, and review the broader research literature on the educational and economic impacts of deworming. We conclude that existing evidence still indicates that mass deworming is a cost-effective health investment for governments in low-income countries where worm infections are widespread.

HIPAA for cancer educators: are you correctly using PHI?

Privacy and confidentiality policies and practices, including Health Insurance Portability and Accountability Act (HIPAA) policies, may vary from institution to institution because they are developed to be institution-specific. HIPAA privacy and security regulations represent the minimum standards, and the expectation is that institutions will develop policies and practices that are reasonable and appropriate for their institution. These privacy and information security safeguards impact the use of sensitive and protected data often used by cancer educators. Therefore, it is important for cancer educators to be familiar with the policies, rules, and guidelines their institution has developed to comply with HIPAA. However, despite institutional differences, certain principles related to the confidentiality, protection, and uses of a patient's health information remain consistent. HIPAA provides two sets of regulations that directly impact the work of many cancer educators: privacy and information security. The HIPAA Privacy Rule includes some security requirements, and HIPAA Security Regulations were designed to ensure privacy of the patient's protected health information (PHI). This paper focuses primarily on the privacy factors.

Use of natural language programming to extract medication from unstructured electronic medical records.

The purpose of this study is to evaluate the feasibility of applying natural language processing in the automated extraction of medications information from unstructured electronic records. Sixty-two documents containing medications were subjected to both manual and automated extraction. Both were able to identify over 90% medications. The automated method identified more medications than manual review, 97% vs 92%. However, the automated extraction included a substantial percentage (17%) of non-medication items but none with manual review.