Our study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedi... more Our study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedicated to increasing the availability of reproductive health services to the poor through training and networking of private med-ical providers. The Kisumu Medical and Educational Trust (KMET) pro-gram focuses on family planning services and encourages providers to add these services to the normal range of consultations, commodity sales, and clinical care they already provide. The study looked at the pool of potential clients of KMET members to evaluate which wealth group benefits from the subsidy given to private providers through the KMET. Analysis of actual KMET clients was used to better understand the program’s success in pro-viding quality reproductive health care. Background Kenya’s population is estimated at 30.7 million, with 80 percent living in rural areas. Total fertility rates for women age 15–49 are 3.12 in urban areas and 5.16 in rural areas, and the contraceptive prevalenc...
Our study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedi... more Our study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedicated to increasing the availability of reproductive health services to the poor through training and networking of private med- ical providers. The Kisumu Medical and Educational Trust (KMET) pro- gram focuses on family planning services and encourages providers to add these services to the normal range of consultations, commodity sales, and clinical care they already provide. The study looked at the pool of potential clients of KMET members to evaluate which wealth group benefits from the subsidy given to private providers through the KMET. Analysis of actual KMET clients was used to better understand the program's success in pro- viding quality reproductive health care.
Tetanus, although an eminently preventable disease, remains common and uncontrolled in many devel... more Tetanus, although an eminently preventable disease, remains common and uncontrolled in many developing countries. The persistence of tetanus is attributable to health service policies that ignore the disease because of a dearth of reliable epidemiologic and economic information. In many developing countries there have, as yet, been few public or professional demands for preventive action. For the prevention of neonatal tetanus, the immediate priority is immunization timed to produce and maintain protective levels of maternal antitoxin during pregnancy. This strategy should be accompanied by the extension and improvement of scientific standards of midwifery. To protect the rest of the population from wound tetanus, the strategy of first choice consists of continuous multiple-antigen immunization in infancy and childhood. Such a program should be reinforced by the routine administration of a toxoid booster following all accidental wounds as well as before all ritual procedures known to carry risk. These strategies, which are of proven efficacy and adaptable to local conditions of the large populations still in need of protection, together provide powerful justification for the expansion of primary maternal and child health services. Careful measurement of the incidence of neonatal tetanus would provide a good indicator of the degree of effectiveness such services have attained in many rural communities.
Background: The current global strategy to reduce the maternal mortality rate in developing count... more Background: The current global strategy to reduce the maternal mortality rate in developing countries focuses on training skilled birth attendants (SBAs) and upgrading existing emergency obstetric facilities. Since the early 1990s, the WHO, UNFPA, UNICEF, and other leaders in maternal and child health have withdrawn support both for training and for establishing linkages with traditional birth attendants. Unfortunately, this policy doesn't address the fact that women in remote rural settings have very poor access to skilled attendants at birth. Methods: A Demographic and Health Survey (DHS) analysis of trends in skilled birth attendance was conducted. The percentage of maternal deaths from each region was calculated to determine what proportion of the burden of regional maternal deaths can be attributed to specific countries with low usage of SBAs. Results: Less than 50% of births were attended by SBAs in the most recent DHS in 35 countries in the world and over the last 20 year...
To evaluate the performance of proxy measures of acculturation and to examine the association bet... more To evaluate the performance of proxy measures of acculturation and to examine the association between acculturation and selected health-risk behaviors. Participants were 1062 Latina pregnant women who received prenatal care at clinics in San Joaquin County, California between 1999 and 2001. We used the receiver-operating characteristic (ROC) curve to characterize the sensitivity and specificity of proxy measures and regression analysis to examine health-risk behaviors. Using the ARSMA-II short version scale as a reference, age at immigration had the highest percentage of correctly classified individuals. Acculturation was significantly associated with a lifetime history of substance use, risky sexual behavior, low fruit consumption, and high fast-food meal consumption. Acculturation is an important predictor of health-risk behavior among women. Further research is needed to better understand the phenomenon and to avert associated adverse health consequences.
Acculturation is conceptualized as a multidimensional process but is typically measured as a conc... more Acculturation is conceptualized as a multidimensional process but is typically measured as a concurrent movement away from culture of origin as a new cultural orientation is obtained. In this study, the authors examined the overall and subscale scoring systems of the ARSMA-II, the most popular acculturation measure, for its associations with stress, pregnancy anxiety, and birthweight in a large sample of pregnant, Mexican-origin women from the Study for Hispanic Acculturation, Reproduction, and the Environment. As predicted, the ARSMA-II's overall acculturation score and two orthogonal subscales, Mexican orientation and Anglo orientation, revealed differing patterns of associations with stress, pregnancy anxiety, and birthweight. Mexican orientation was negatively associated with stress, positively associated with pregnancy anxiety, and not associated with birthweight. Anglo orientation was positively associated with stress and negatively associated with birthweight. The gains t...
The COVID-19 pandemic has highlighted bottlenecks in large-scale, frequent testing of populations... more The COVID-19 pandemic has highlighted bottlenecks in large-scale, frequent testing of populations for infections. PCR-based diagnostic tests are expensive, reliant on expensive centralized labs, can take days to deliver results, and are prone to backlogs and supply shortages. Antigen tests, that bind and detect the surface proteins of a virus, are rapid and inexpensive but suffer from high false negative rates. To address this problem, we have created an inexpensive, simple, and robust 60-minute Do-It-Yourself (DIY) workflow to detect viral RNA from nasal swabs or saliva with high sensitivity (0.1 to 2 viral particles/µl) and specificity (>97% True Negative Rate) utilizing reverse transcription loop-mediated isothermal amplification (RT-LAMP).Our workflow, ALERT (Accessible LAMP-Enabled Rapid Test), incorporates the following features: 1) Increased shelf-life and ambient temperature storage by using wax layers to isolate enzymes from reaction, 2) Improved specificity by using seq...
Our study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedi... more Our study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedicated to increasing the availability of reproductive health services to the poor through training and networking of private med-ical providers. The Kisumu Medical and Educational Trust (KMET) pro-gram focuses on family planning services and encourages providers to add these services to the normal range of consultations, commodity sales, and clinical care they already provide. The study looked at the pool of potential clients of KMET members to evaluate which wealth group benefits from the subsidy given to private providers through the KMET. Analysis of actual KMET clients was used to better understand the program’s success in pro-viding quality reproductive health care. Background Kenya’s population is estimated at 30.7 million, with 80 percent living in rural areas. Total fertility rates for women age 15–49 are 3.12 in urban areas and 5.16 in rural areas, and the contraceptive prevalenc...
Our study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedi... more Our study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedicated to increasing the availability of reproductive health services to the poor through training and networking of private med- ical providers. The Kisumu Medical and Educational Trust (KMET) pro- gram focuses on family planning services and encourages providers to add these services to the normal range of consultations, commodity sales, and clinical care they already provide. The study looked at the pool of potential clients of KMET members to evaluate which wealth group benefits from the subsidy given to private providers through the KMET. Analysis of actual KMET clients was used to better understand the program's success in pro- viding quality reproductive health care.
Tetanus, although an eminently preventable disease, remains common and uncontrolled in many devel... more Tetanus, although an eminently preventable disease, remains common and uncontrolled in many developing countries. The persistence of tetanus is attributable to health service policies that ignore the disease because of a dearth of reliable epidemiologic and economic information. In many developing countries there have, as yet, been few public or professional demands for preventive action. For the prevention of neonatal tetanus, the immediate priority is immunization timed to produce and maintain protective levels of maternal antitoxin during pregnancy. This strategy should be accompanied by the extension and improvement of scientific standards of midwifery. To protect the rest of the population from wound tetanus, the strategy of first choice consists of continuous multiple-antigen immunization in infancy and childhood. Such a program should be reinforced by the routine administration of a toxoid booster following all accidental wounds as well as before all ritual procedures known to carry risk. These strategies, which are of proven efficacy and adaptable to local conditions of the large populations still in need of protection, together provide powerful justification for the expansion of primary maternal and child health services. Careful measurement of the incidence of neonatal tetanus would provide a good indicator of the degree of effectiveness such services have attained in many rural communities.
Background: The current global strategy to reduce the maternal mortality rate in developing count... more Background: The current global strategy to reduce the maternal mortality rate in developing countries focuses on training skilled birth attendants (SBAs) and upgrading existing emergency obstetric facilities. Since the early 1990s, the WHO, UNFPA, UNICEF, and other leaders in maternal and child health have withdrawn support both for training and for establishing linkages with traditional birth attendants. Unfortunately, this policy doesn't address the fact that women in remote rural settings have very poor access to skilled attendants at birth. Methods: A Demographic and Health Survey (DHS) analysis of trends in skilled birth attendance was conducted. The percentage of maternal deaths from each region was calculated to determine what proportion of the burden of regional maternal deaths can be attributed to specific countries with low usage of SBAs. Results: Less than 50% of births were attended by SBAs in the most recent DHS in 35 countries in the world and over the last 20 year...
To evaluate the performance of proxy measures of acculturation and to examine the association bet... more To evaluate the performance of proxy measures of acculturation and to examine the association between acculturation and selected health-risk behaviors. Participants were 1062 Latina pregnant women who received prenatal care at clinics in San Joaquin County, California between 1999 and 2001. We used the receiver-operating characteristic (ROC) curve to characterize the sensitivity and specificity of proxy measures and regression analysis to examine health-risk behaviors. Using the ARSMA-II short version scale as a reference, age at immigration had the highest percentage of correctly classified individuals. Acculturation was significantly associated with a lifetime history of substance use, risky sexual behavior, low fruit consumption, and high fast-food meal consumption. Acculturation is an important predictor of health-risk behavior among women. Further research is needed to better understand the phenomenon and to avert associated adverse health consequences.
Acculturation is conceptualized as a multidimensional process but is typically measured as a conc... more Acculturation is conceptualized as a multidimensional process but is typically measured as a concurrent movement away from culture of origin as a new cultural orientation is obtained. In this study, the authors examined the overall and subscale scoring systems of the ARSMA-II, the most popular acculturation measure, for its associations with stress, pregnancy anxiety, and birthweight in a large sample of pregnant, Mexican-origin women from the Study for Hispanic Acculturation, Reproduction, and the Environment. As predicted, the ARSMA-II's overall acculturation score and two orthogonal subscales, Mexican orientation and Anglo orientation, revealed differing patterns of associations with stress, pregnancy anxiety, and birthweight. Mexican orientation was negatively associated with stress, positively associated with pregnancy anxiety, and not associated with birthweight. Anglo orientation was positively associated with stress and negatively associated with birthweight. The gains t...
The COVID-19 pandemic has highlighted bottlenecks in large-scale, frequent testing of populations... more The COVID-19 pandemic has highlighted bottlenecks in large-scale, frequent testing of populations for infections. PCR-based diagnostic tests are expensive, reliant on expensive centralized labs, can take days to deliver results, and are prone to backlogs and supply shortages. Antigen tests, that bind and detect the surface proteins of a virus, are rapid and inexpensive but suffer from high false negative rates. To address this problem, we have created an inexpensive, simple, and robust 60-minute Do-It-Yourself (DIY) workflow to detect viral RNA from nasal swabs or saliva with high sensitivity (0.1 to 2 viral particles/µl) and specificity (>97% True Negative Rate) utilizing reverse transcription loop-mediated isothermal amplification (RT-LAMP).Our workflow, ALERT (Accessible LAMP-Enabled Rapid Test), incorporates the following features: 1) Increased shelf-life and ambient temperature storage by using wax layers to isolate enzymes from reaction, 2) Improved specificity by using seq...
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