Testing the Effectiveness of a Community-Based Peer Support Intervention to Mitigate Social Isolation and Stigma of Adolescent Motherhood in Zimbabwe.

OBJECTIVES: Social isolation and stigma contribute to poor mental health outcomes. Adolescent mothers in Zimbabwe often experience isolation and stigma, lacking social support and resources to navigate motherhood. The study tested the effectiveness of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe. METHODS: Community health workers (n = 12) and peer educators (n = 12) in the intervention arm were recruited and trained on co-facilitating peer support groups. Adolescent mothers aged 15-18 years from two low-income high-density communities in Harare were recruited, using a quasi-experimental design. The intervention arm (n = 104) participated in the peer support groups and both arms completed sociodemographic, base-, mid-, and end-line surveys (control arm n = 79). Peer support groups (12 groups with 6-12 participants in each) met in-person twice a month and completed 12 sessions from May to August 2019 addressing participant-identified topics such as income generation and depression. WhatsApp Messenger was used for training and implementation support. Key community stakeholders discussed project progress and recommendations to improve adolescent mothers' health. Data were analyzed using Stata 15. RESULTS: The intervention arm reported lower depressive symptoms and common mental disorders and higher overall, family, friends, and significant-other support, compared to control. The intervention arm felt more engaged with peers, knew who and where to turn to for help, and had coping, parenting and communication strategies to manage life challenges. CONCLUSIONS FOR PRACTICE: The intervention mitigated social isolation and stigma and thereby improved mental health and social support among adolescent mothers in Harare. Trial Registration This trial is registered at Clinical Trials.gov, NCT05213182 https://clinicaltrials.gov/ct2/show/NCT05213182 .

What is already known on this subject? Social isolation and stigma contribute to poor mental health outcomes. Adolescent mothers often experience isolation and stigma, lacking social support and resources to navigate motherhood. There is a need for interventions that identify and address the unique needs of adolescent mothers.What this study adds? A community-based peer-support intervention can mitigate social isolation and stigma and thereby improve mental health and social support of adolescent mothers. WhatsApp Messenger is a potential intervention tool for providing training and implementation support, and enhancing communication between peer support group facilitators and participants.

Development and assessment of feasibility of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe.

BACKGROUND: Adolescent mothers in Zimbabwe often experience stigma, isolation, and lack coping skills and resources to successfully navigate motherhood. Social isolation and stigma are linked to poor mental health outcomes. No interventions currently address mental health of adolescent mothers in Zimbabwe. Peer support groups in other contexts have been effective at increasing social connectedness, self-esteem, and self-efficacy, providing coping mechanisms to manage stigma experiences, in addition to empowering and improving mental health of adolescents and adolescent mothers. To develop a community-based peer support intervention, we aimed to understand the unique needs of adolescent mothers, how peer support groups could address those needs, and the feasibility of implementing the intervention. METHODS: Focus group discussions were conducted with 86 adolescent mothers aged 14-18 years, 24 community health workers, and 25 key community stakeholders in a low-income high-density community in Harare. Data were analyzed thematically using NVivo 12 software. RESULTS: Participants described adolescent mother experiences with stigma and social isolation, in addition to challenges including gossip, lack of employment and educational opportunities, and gaps in services and programming. Peer support groups for adolescent mothers were welcomed to improve mental health, social support, knowledge sharing, and skills building. Participants identified varying preferred frequency and duration of group sessions addressing topics including income generation, mental health, and gossip, facilitated by community health workers at health and community centers. The use of WhatsApp Messenger to support intervention efforts was welcomed as an affordable and user-friendly platform to share information. Implementation (i.e., training, supervision, frequency, location, and co-facilitation) was feasible. CONCLUSIONS: Adolescent mothers, community health workers and key community stakeholders welcomed the peer support groups as a feasible way to address the mothers' needs.

Building Implementation Science in Nutrition.

The field of nutrition has been investing in the development of many nutrition-specific and -sensitive policies and programs aimed at improving population-level malnutrition in all its forms. When there is a need to learn about a new system, programmatic context, or target population to understand how to effectively deploy an intervention to help improve nutrition, it is important to be able to ask a broad range of questions, both in topic and in scope. Our aim is to provide a simple and conceptually clear definition and principles to elaborate the science of implementation for nutrition to distinguish it from other ways of knowing and learning and to serve as a guide to the articulation of implementation science questions and methods. Implementation science is a body of systematized knowledge about how to improve implementation that 1) is distinguished by its aims to learn about the process of implementation, 2) uses methods that derive from and fit with the aims, and 3) is built with tacit (as well as expert) knowledge and experiential learning. Implementation science aims to generate the learning needed to improve implementation through facilitating collaboration among stakeholders to articulate and pursue the aims; capturing and using tacit knowledge and experiential learning from stakeholders, systems, providers, and recipients; and applying a mix of methods suited to the aims. This elaboration of the science provides a simple way to help those who already do, or want to do, implementation science understand and communicate how this science is unique and the value that it adds to the current landscape of nutrition priorities, innovations, and the attendant complex learning needs that follow. Implementation science encompasses both discovery- and mission-oriented research, and centers implementation as the object of study for the purposes of broad-based learning.

Taxonomy of Seniors' Needs for Food and Food Assistance in the United States.

Food insecurity results in poor health among seniors. Food and nutrition assistance targeted to seniors experiencing or at risk of food insecurity prevents poor health outcomes and enables seniors to age in place. Currently, the primary modes of service delivery are targeted to seniors who are older and frailer than average, rendering these modes less responsive to the needs of the broader population of food-insecure seniors and limiting the preventive potential of food assistance. This study aimed to understand needs among seniors for food and food assistance and to develop a comprehensive taxonomy for these needs. The taxonomy depicts seniors' self-identified needs that relate to their ability to access and use food and nutrition assistance across three domains: physical abilities, consuming food, and access and use of transportation. The results of this study are intended to provide in-depth information to support effective alignment of programs with seniors' needs.

Nutrition Intervention Using Behavioral Change Communication without Additional Material Inputs Increased Expenditures on Key Food Groups in Bangladesh.

BACKGROUND: Behavioral change communication (BCC) promotes skills and knowledge to improve infant and young child feeding, but without additional material inputs, recipients must develop strategies to translate knowledge into action. Using data from the Alive & Thrive initiative in Bangladesh (2010-2014), we aimed to test whether households receiving the intensive intervention (opposed to the nonintensive intervention) increased expenditures on key foods for mothers and children (e.g., foods that were promoted by the intervention and also changed in maternal and child diets). METHODS: The intensive intervention provided interpersonal counseling, community mobilization, and mass media campaigns to promote breastfeeding and complementary feeding. A cluster-randomized design compared 20 subdistricts randomly assigned to the intensive (4281 households) or nonintensive (4284 households) intervention. Measures included food and nonfood expenditures, dietary diversity, and women's economic resources. Linear and logistic regression tested difference-in-differences (DD) in expenditures and dietary diversity, accounting for subdistricts as clusters, and the association between maternal and child consumption of specific food groups and corresponding food expenditures. RESULTS: Expenditures on eggs and flesh foods increased more in intensive areas than in nonintensive areas by 53 (P < 0.01) and 471 (P < 0.01) taka/mo, respectively. Household food expenditures increased more in intensive areas by 832 taka (P = 0.02), whereas changes in nonfood expenditures did not differ. Women's employment and control of income increased more in intensive areas by 12 (P = 0.03) and 13 (P < 0.01) percentage points, respectively, while jewelry ownership decreased more by 23 percentage points (P < 0.01). Higher expenditures on food groups were reflected in higher consumption by women and children. CONCLUSIONS: Recipients in the intensive intervention mobilized additional resources to improve diets, reflected in increased expenditures and consumption of promoted foods. BCC interventions should document how recipients produce desired results without additional material inputs, particularly for behaviors that likely require additional resources. This trial was registered at clinicaltrials.gov as NCT01678716.

Effect of biochar amendment on sorption-desorption and dissipation of 17α­ethinylestradiol in sandy loam and clay soils.

Animal manure application in agricultural land has caused the release of steroid estrogens in the soil environment and further movement to aquatic systems. The objective of this study was to investigate the effects of biochar addition on sorption-desorption and dissipation behaviors of 17α­ethinylestradiol (EE2) in two different textured soils. A Commerce sandy loam and a Shakey clay were selected and subjected to sterilization. Soil samples with and without sterilization were reacted with a series of EE2 solutions of different concentrations for sorption followed by desorption and quantification using HPLC-MS/MS. Long-term dissipation of EE2 in the same soils was also evaluated over a 30-d incubation. Biochar amendment increased the maximum EE2 sorption capacity but decreased its water desorption in both sandy loam and clay soils. On other hand, biochar addition increased the Koc in the clay soil which had low EE2 sorption efficiency but decreased Koc in the sandy loam which had high EE2 sorption efficiency. Biochar did significantly increase both desorbable and non-extractable fractions of EE2, while it reduced the bioavailability of EE2 to microbial degradation. The dissipation of EE2 in non-sterilized soils fit to the first-order kinetic model, whereas it was better described by zero-order kinetic for sterilized soil. Biochar increased the half-life of EE2 dissipation in non-sterilized Commerce sandy loam soil by 48% (from 3.63 to 5.37 d) and in non-sterilized Sharkey clay soil by 67% (from 2.28 to 3.81 d). Overall, this study demonstrated positive impacts of biochar on the retention of estrogen hormones in soils.

Food Insecurity Mediates the Effect of a Poverty-Alleviation Program on Psychosocial Health among the Ultra-Poor in Bangladesh.

BACKGROUND: Poor psychosocial health is a major global burden. A challenge to improving psychosocial health is that its associations with risk factors are complicated, inadequately understood, and difficult to modify, and/or require action outside the health sector. OBJECTIVE: We capitalized on the quasi-experimental assignment of a poverty-alleviation program for the ultra-poor in Bangladesh to investigate how this program affected 2 aspects of psychosocial health; distress, (i.e., the negative cognitive appraisal of stress) and subjective well-being (i.e., satisfaction with domains of life), and the importance of food insecurity as a mediator relative to other stressors and economic status. METHODS: The study was conducted in 3 northern districts of Bangladesh where the program operated. The ultra-poor households were selected through a multistage selection process. The economically better-off households were excluded during the process and included as study controls. The program supported women by providing income-earning opportunities, strengthening sociopolitical livelihood, and building self-awareness and self-confidence. Data were collected in 2006 from 209 women on demography, psychosocial health, and stressors (i.e., domestic violence, food insecurity, economic status, perceived economy, and emotional social constraints). Data collected in 2002 from the same individuals were used to control for the baseline differences between groups. By using path analysis we showed the direct and indirect effects of the program on distress and well-being. RESULTS: The program positively affected psychosocial health by alleviating stressors. The indirect effect of the program contributed 74% in reducing distress and 30% in improving well-being. Food insecurity was by far the most important mediator, explaining 50% of indirect effect on distress and 66% of the indirect effect on well-being. CONCLUSION: Food insecurity is modifiable and an appropriate target for poverty-alleviation and agricultural programs. These findings suggest programmatic and policy attention to the social dimensions of poor psychosocial health, particularly to food insecurity as a central cause.

Measures and indicators for assessing impact of interventions integrating nutrition, health, and early childhood development.

When implementing interventions integrating nutrition, health, and early childhood development, evaluation studies of effectiveness that assess the intermediate and ultimate impacts on the four domains of food and nutrition, family care, health, and child development are needed. Such studies should demonstrate impact, both benefits and potential harms, and understand mechanisms through which impact has been achieved. This article reviews and suggests measures and indicators suitable for use in evaluation studies of effectiveness of integrated interventions for children under 5 years of age. Within each of the four domains, multiple constructs and subconstructs were considered. For each construct and subconstruct, we identified measures and indicators, using several search processes, and reviewed them in relation to validity, responsiveness to intervention inputs and activities, equivalence in constructs and items across contexts with appropriate adaptation, and feasibility for use in effectiveness studies. Suggested measures and indicators for each domain, construct, and subconstruct are tabulated and described. We discuss the strengths and weaknesses of measures and indicators across domains and constructs, further research establishing validity, and guidance on adaptation of measures to particular contexts.

"Roll-bar" for protective posture splint limits potential trauma to dorsal hand grafts.

The expectation of excellent functional and cosmetic outcomes adds to the challenges of managing the burned hand. The initial fragility of the grafted surface warrants extra measures of protection. A "roll-bar " attached to a splint over a grafted area can serve as protection against mechanical trauma. Two "intrinsic plus " protective posture splints were fabricated; one had a roll-bar extending from the D2 ray to the distal forearm. Three simulated patients wearing each of the splints attempted to contact the bed rail from supine. Pictures, transferred ink, observation, and subjective comments were used to establish percentage of the surface at risk because of bed rail contact and its ease. Without the roll-bar 100% of the dorsal surface of the hand was accessible to contact with the bed rail. With the roll-bar all subjects were prevented from contact to the dorsum of the hand and contact to the dorsal fingers was less than 40% in all subjects, decrease of risk at the wrist was also significant. The roll-bar can prevent mechanical trauma to grafts on the fingers and dorsum of the hand because of contact with the bed rail. The ease of the application and the potential benefits to patient outcome make it an appropriate addition to the protective posture splint when seeking to minimize area of the surface at risk.