Water, Sanitation, and Hygiene Infrastructure and Resources in Schools in Belize during the COVID-19 Pandemic, 2021-2023.

Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (-11%), functional handwashing access points accessible for individuals with disabilities (-17%) and small children (-29%), and functional alcohol-based hand rub dispensers (-13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures.

Increasing colorectal cancer screening orders using unlicensed assistive personnel.

Background: Colorectal cancer (CRC) is among the leading cancer diagnoses affecting both men and women worldwide. Prevention and early detection of CRC is possible by increasing access to and utilisation of screening tests. Although CRC screening is highly recommended, screening rates remain suboptimal in the USA, particularly among underserved populations. Our project site, an urban federally qualified health centre, was not meeting the national screening target of 80% of eligible adults. Objective: The aim of this quality improvement project was to increase the number of orders for CRC screening to eligible patients by using unlicensed assistive personnel and automated telephone outreach calls to offer 100 patients CRC screening during an 8-week period. Methods: 40 patients received outreach calls from care coordinators (CC). 40 patients received automated telephone call reminders to call a CC to obtain an order for CRC screening. 20 patients were offered CRC screening by a medical assistant (MA) as part of their scheduled office visits. We used two plan-do-study-act (PDSA) cycles to deliver these three screening interventions. Results: A total of 100 patients received one of the interventions. Ten of those patients received an order for either colonoscopy or faecal immunochemical testing by the conclusion of the second PDSA cycle. The MA-offered screening resulted in the highest percentage of patients accepting CRC screenings and patients preferred this outreach approach compared with CC outreach or automated voice messages. CC outreach yielded a lower rate of accepted screenings. None of the patients who received the automated calls followed up to obtain a screening order. Conclusion: Our project demonstrates that unlicensed assistive personnel have the potential to increase patient access to CRC screening.

Child maltreatment in Puerto Rico: findings from the 2010 National Child Abuse and Neglect Data System.

OBJECTIVE: Child maltreatment can have long-term adverse effects. Quantifying the scope and characteristics of child maltreatment is necessary for effective prevention in Puerto Rico. METHODS: The National Child Abuse and Neglect Data System Child File contains all the reports of child maltreatment from the United States (US) and Puerto Rico. A child maltreatment victim is defined as a child whose maltreatment was substantiated or indicated by the local child protective agency. We compared reporting and victimization rates and reporting sources in Puerto Rico, with those in the US and examined characteristics of child maltreatment in Puerto Rico. RESULTS: During 2006-2010, a total of 31,849-40,712 cases of child maltreatment were reported annually in Puerto Rico. Victimization rates are consistently higher in Puerto Rico than in the US (10.7/1,000-14.8/1,000 in Puerto Rico vs. 10.1/1,000-12.1/1,000 in the US), despite consistently lower reporting rates. In 2010, victimization rates were highest among children aged 1-6 years. In Puerto Rico, neglect is the most common form of maltreatment, followed by emotional abuse; however, the majority of victims suffered multiple types of abuse. Reporting was more commonly anonymous in Puerto Rico (29.8%) than in the US (9.4%) and less commonly provided by professionals in Puerto Rico (37.2%) than in the US (58.7%). CONCLUSION: We identified a high prevalence of child maltreatment in Puerto Rico. A lower reporting rate, higher victimization rate, and substantial percentage of anonymous reporting indicate potential underreporting of child maltreatment in Puerto Rico. Increasing the awareness and training professionals for improved child maltreatment identification could help alleviate the problem of underreporting.

Ethnic inequality in Guatemalan women's use of modern reproductive health care.

CONTEXT: Guatemala has some of the poorest reproductive health indices and largest disparities in health in Latin America, particularly between indigenous and ladina women. To reduce these disparities, it is necessary to understand how indigenous women's disadvantages in linguistic, socioeconomic or residential characteristics relate to their underutilization of reproductive health services. METHODS: Logistic regression analyses of a nationally representative sample of women aged 15-49 from the 2008-2009 National Survey of Maternal and Infant Health were used to estimate ethnic disparities in women's use of institutional prenatal care and delivery, and in met demand for modern contraceptives. Using predicted probabilities, we estimated the extent to which these disparities were attributable to a language barrier among indigenous women and to their disadvantage in selected socioeconomic and residential characteristics. RESULTS: The ethnic difference in use of institutional prenatal care was small; however, institutional delivery was far less common among indigenous women than among ladina women (36% vs. 73%), as was met need for modern contraceptives (49% vs. 72%). Not speaking Spanish accounted for the largest portion of these ethnic differentials. Indigenous women's poor education and rural residence made up smaller portions of the ethnic differential in modern contraceptive use than did their economic disadvantage. CONCLUSION: The large proportion of indigenous women who use institutional prenatal care suggests that further integrating the three services may increase their use of institutional delivery and modern contraceptives. Adding speakers of local Mayan languages to the staff of health facilities could also help increase use.

Exploring the connections between HIV serostatus and individual, household, and community socioeconomic resources: evidence from two population-based surveys in Kenya.

The positive association between health and socioeconomic status (SES) is well documented. However, available empirical evidence on the SES gradients of HIV serostatus is mixed, and few studies have explored the effects of community SES indicators on individual's HIV risk. Using nationally representative data of women and men from the 2003 Demographic and Health Survey and the 2007 AIDS Indicator Survey from Kenya, we assessed the associations between HIV serostatus and SES as measured by educational attainment and household wealth at the individual/household and community levels. Additionally, we explored changes in these associations between 2003 and 2007. Results from bivariate and cohort analyses showed that during this period, HIV burden shifted from higher to lower SES subgroups at both the individual/household and community levels, particularly among women aged 15-24 years. Results from multi-level logistic regression models showed that this shift was generally significant among women. In addition, communities' collective educational attainment, measured as the percentage of residents with some secondary schooling or higher, was a more significant predictor and protective factor for HIV risk than individual/household-level SES indicators for women in 2007 and men in both years. Our findings highlight the relevance of community-level SES to HIV dynamics in Kenya between 2003 and 2007.

Intolerance of uncertainty and decisions about delayed, probabilistic rewards.

Worry is the inflated concern about potential future threats and is a hallmark feature of generalized anxiety disorder. Previous theoretical work has suggested that worry may be a consequence of intolerance of uncertainty (IU). The current study seeks to explore the behavioral consequences of IU. Specifically, we examine how IU might be associated with aspects of reward-based decision making. We utilized a simple laboratory gambling task in which participants chose between small, low-probability rewards available immediately at the beginning of each trial and large, high-probability rewards only available after some variable delay. Results demonstrate that higher levels of intolerance of uncertainty were associated with a tendency to select the immediately available, but less valuable and less probable rewards. IU also predicted decision-makers' sensitivity to outcomes. We discuss the cognitive and affective mechanisms that are likely to underlie the observed decision-making behavior and the implications for anxiety disorders.

Prevalence and correlates of sexual risk behaviors among Jamaican adolescents.

CONTEXT: Despite high levels of sexual activity and risk behaviors among Jamaican youth, few population-based studies have examined their prevalence or correlates. METHODS: The prevalence of three sexual risk behaviors was assessed using data from the 2008-2009 Jamaican ?Reproductive Health Survey on a subsample of adolescents aged 15-19 who neither were in a union nor had a child. Factors associated with the risk behaviors were examined separately for females and males, using bivariate analysis and multivariate logistic regression. RESULTS: In the year prior to the survey, 32% of females and 54% of males had had sexual intercourse; of those, 12% and 52%, respectively, had had more than one sexual partner, and 49% and 46% had used condoms ?inconsistently or not at all. School enrollment was protective against females being sexually active and males having multiple partners. Females who were enrolled in an age-appropriate or higher grade had decreased odds of using condoms inconsistently or not at all, and males who were enrolled in a lower than age-appropriate grade had a decreased risk of being sexually active. Males in the lowest wealth tercile were less likely than those in the highest tercile to have been sexually active or to have had multiple partners. Weekly attendance at religious services was protective against all three risk behaviors for both genders, with the exception of inconsistent or no condom use among males. CONCLUSIONS: Future reproductive health programs should continue to target adolescents in venues other than schools and churches, and should also address the varying needs of females and males.

The problems of eligibility and endogenous confounders when assessing the mortality impact of a nationwide disease-prevention programme: the case of insecticide-treated nets in Togo.

Evaluation of the mortality impact of nationwide disease-prevention efforts is complicated by potential endogeneity: programme recipients may have unobserved characteristics that simultaneously make them both more likely to become recipients and more likely to survive as a result of other health practices. This population-based study assesses the mortality impact of a nationwide programme that distributed insecticide-treated nets (ITNs) to mothers of children aged 9-59 months in Togo. By comparing mortality rates before and after the programme according to households' eligibility status, we demonstrate that a one-time programme that restricts eligibility to households with a surviving child excludes some households with a high risk of child mortality. We then apply simultaneous estimation models to untangle the mortality impact of ITNs from the effects of unobserved confounders and show that among eligible households, living in a household with ITNs significantly reduces mortality for children aged 20-59 months, even after controlling for endogeneity.

Exploring the associations between intimate partner violence and women's mental health: evidence from a population-based study in Paraguay.

Using a nationally representative sample from the 2008 Paraguayan National Survey of Demography and Sexual and Reproductive Health, we examine the association between emotional, physical, and sexual intimate partner violence (IPV) and mental health among women aged 15-44 years who have ever been married or in a consensual union. The results from multivariate logistic regression models demonstrate that controlling for women's socioeconomic and marital status and history of childhood abuse and their male partners' unemployment and alcohol consumption, IPV is independently associated with an increased risk for common mental disorders (CMD) and suicidal ideation measured by the Self Reporting Questionnaire (SRQ-20). IPV variables substantially improve the explanatory power of the models, particularly for suicidal ideation. Emotional abuse, regardless of when it occurred, is associated with the greatest increased risk for CMD whereas recent physical abuse is associated with the greatest increased risk for suicidal ideation. These findings suggest that efforts to identify women with mental health problems, particularly suicidal ideation, should include screening for the types and history of IPV victimization.

The Role of Ethnicity in Father Absence and Children's School Enrollment in Guatemala.

Despite the historical prevalence of single motherhood in Latin America and its rise in recent years, there is limited knowledge on the magnitude and consequences of father absence as experienced by children. Using a nationally representative sample from the 2002 Guatemalan Reproductive Health Survey, this study provides unprecedented documentation on the national prevalence of children's separate living arrangements from their biological fathers and nonresident fathers' paternity establishment and child support payments. Using random-intercept models, this study further demonstrates that father absence has a negative effect on the school enrollment of indigenous children of both sexes and Ladino male children. Increased poverty in father-absent households explains a smaller proportion of this adverse effect on indigenous children, suggesting that their fathers, when present, play a stronger social, rather than economic, role compared to their Ladino counterparts. Finally, child support payments attenuate the negative effects of father absence, particularly among Ladino male children.

Perinatal risk for common mental disorders and suicidal ideation among women in Paraguay.

OBJECTIVE: To examine the association between mental health problems among pregnant women and those in the postpartum period using a nationally representative sample of 6538 women aged 15-49 years from the National Survey of Demography and Sexual and Reproductive Health in Paraguay. METHODS: The predicted probabilities (PP) of common mental disorders (CMD) and suicidal ideation were assessed using the Self-Reporting Questionnaire (SRQ-20) and logistic regression models. RESULTS: No evidence was found of an increased risk for mental health problems associated with being pregnant or in the postpartum period alone. The risk for CMD during pregnancy and the postpartum period and for suicidal ideation during pregnancy was significantly greater when the pregnancy was unintended. In addition, unintentionally pregnant women who had neither been in a union nor had a child were at a significantly higher risk for CMD and suicidal ideation compared with non-pregnant and non-postpartum women (PP: 0.54 versus 0.21 for CMD risk and 0.15 versus 0.02 for suicidal ideation). However, there were no significant differences by marital status among postpartum women. CONCLUSION: The significant effects of pregnancy intention and marital status highlight the importance of psychosocial, rather than physiological, contexts in which women experience pregnancy and childbirth.

Fertility decline in Paraguay.

Recent reproductive health surveys show that the fertility rate in Paraguay decreased precipitously from 4.3 lifetime births per woman in 1995-98 to 2.9 births in 2001-04. In this study, we establish data consistency between the 1998 and 2004 surveys by comparing a series of cohort-specific period rates and use the Bongaarts framework of proximate determinants of fertility to demonstrate that an increase in the contraceptive prevalence rate (CPR) between 1998 and 2004 fully accounts for the fertility decline. Decomposition of rates shows that changes in group-specific CPRs explain a greater proportion of the change in the overall CPR than do changes in population composition by educational attainment, urban residence, region, and language spoken at home. Finally, we show that younger cohorts of women in 2004 reported ideal completed fertility desires of less than 2.9 births, suggesting that the fertility rate is likely to continue to decrease.