AIDS Response Research Articles

A Novel Method to Measure Resilience in Nutrition: Application to Diets and Body Mass Index of Rural Women in Nepal and Bangladesh (FS01-02-19)

ObjectivesThis study aimed to demonstrate feasibility of a novel method for measuring resilience in dietary diversity (DD) and body mass index (BMI) of rural women of reproductive age (WRA) in Nepal and Bangladesh. Resilience is defined as the population’s ability to recover from adverse shocks, measured relative to statistical mean reversion. MethodsWe used regionally representative surveys from Nepal (n = 2187) and Bangladesh (n = 1715) collected annually in Nepal (four panels, 2013–2016) and every 6 months in Bangladesh (3 panels, 2016–2017), for BMI (kg/m2) and DD using 10 food groups (7-day qualitative diet recall, Nepal) and 6 food groups (24-hour diet recall, Bangladesh). We estimated where i is the woman, y is the outcome of interest, and z is a vector of controls. ∆yi, t+j denotes change in y between t + j-1 and t + j. Declinedi,t+1 equals 1 if the change between t and t + 1 is negative, zero otherwise. β2 measures the degree of reversal in decline controlling for mean reversion (β1) and other differences (age, age2, age cube, and socioeconomic status). β2 = 0 is our benchmark of mean reversion around the trend, i.e., recoveries after decline are not significantly different from declines after recovery. ResultsOur technique revealed significant (P < 0.01) resilience of DD in Nepal (Figure 1, Panel A). Among 1682 women in the Terai region, 47% (n = 784) experienced an initial decline in DD, and 61% of that initial decline was recovered. Mean reversion removed only 25% of the initial change among those who gained. We found no significant resilience in Bangladesh (Figure 1, Panel B) or for BMI in either country. ConclusionsThe resilience of DD in Nepal could reflect food aid responses to the 2015 earthquake or other interventions, while lack of resilience in BMI could reflect time lags, measurement errors or limits on the speed and timing of weight change. Lack of resilience of DD in Bangladesh could reflect shorter time intervals. Future work will apply this method to test for differences in resilience associated with exposure to programmatic interventions. Funding SourcesSupport provided by Feed the Future Innovation Lab for Nutrition, funded by the United States Agency for International Development (USAID). Supporting Tables, Images and/or Graphs▪

A Novel Method to Measure Resilience in Nutrition: Application to Diets and Body Mass Index of Rural Women in Nepal and Bangladesh (FS01-02-19)

ObjectivesThis study aimed to demonstrate feasibility of a novel method for measuring resilience in dietary diversity (DD) and body mass index (BMI) of rural women of reproductive age (WRA) in Nepal and Bangladesh. Resilience is defined as the population’s ability to recover from adverse shocks, measured relative to statistical mean reversion. MethodsWe used regionally representative surveys from Nepal (n = 2187) and Bangladesh (n = 1715) collected annually in Nepal (four panels, 2013–2016) and every 6 months in Bangladesh (3 panels, 2016–2017), for BMI (kg/m2) and DD using 10 food groups (7-day qualitative diet recall, Nepal) and 6 food groups (24-hour diet recall, Bangladesh). We estimated where i is the woman, y is the outcome of interest, and z is a vector of controls. ∆yi, t+j denotes change in y between t + j-1 and t + j. Declinedi,t+1 equals 1 if the change between t and t + 1 is negative, zero otherwise. β2 measures the degree of reversal in decline controlling for mean reversion (β1) and other differences (age, age2, age cube, and socioeconomic status). β2 = 0 is our benchmark of mean reversion around the trend, i.e., recoveries after decline are not significantly different from declines after recovery. ResultsOur technique revealed significant (P < 0.01) resilience of DD in Nepal (Figure 1, Panel A). Among 1682 women in the Terai region, 47% (n = 784) experienced an initial decline in DD, and 61% of that initial decline was recovered. Mean reversion removed only 25% of the initial change among those who gained. We found no significant resilience in Bangladesh (Figure 1, Panel B) or for BMI in either country. ConclusionsThe resilience of DD in Nepal could reflect food aid responses to the 2015 earthquake or other interventions, while lack of resilience in BMI could reflect time lags, measurement errors or limits on the speed and timing of weight change. Lack of resilience of DD in Bangladesh could reflect shorter time intervals. Future work will apply this method to test for differences in resilience associated with exposure to programmatic interventions. Funding SourcesSupport provided by Feed the Future Innovation Lab for Nutrition, funded by the United States Agency for International Development (USAID). Supporting Tables, Images and/or Graphs▪

Insights from outside BJOG

Insights from outside BJOG

Reporting of surgical response to disasters in low-income and middle-income countries: a literature review

Abstract Background Natural and man-made disasters can overwhelm the capacity of surgical systems in low-income and middle-income countries (LMICs). Most studies addressing peri-disaster surgical care focus on international relief efforts rather than on how disasters stress local surgical capacity. Our understanding of factors that affect the ability of health systems to absorb increased volume and case-complexity is poor. We conducted a structured literature review to identify whether components of capacity were reported as part of surge response in local surgical care after disasters. Methods We searched PubMed and Medline databases for articles published between January, 2008, and August, 2018, using English language search terms for LMICs, surgery, and disasters. We extracted information about the WHO region, disaster classification, and the components of surge capacity using the 4S framework: Staff (human resources), Stuff (equipment/supplies), Space (infrastructure), and Systems (logistics). The 4S components were further classified by data quality into the following categories: quantitative description, qualitative description, or no description. Findings We identified 7704 articles but after applying exclusion criteria, including foreign aid response, we selected 84 articles for analysis. Most articles (59/84 [70%]) described earthquakes and 40/84 (48%) reported events in the Western Pacific region. Using the 4S framework, we identified articles that reported quantitative data: 16 (19%) for Staff, 3 (4%) for Stuff, 21 (25%) for Space, and 9 (11%) for Systems. Despite a low threshold for quantitative categorisation, only 1/84 (1%) articles described all four components with quantitative data. By comparison, 51/84 (61%) articles provide no quantitative data on any of the four components. Interpretation There is no organised framework for evaluation of surgical surge capacity in disasters. Our analysis shows that there are very few descriptions of capacity within disaster literature and a limited understanding of LMIC health system response to surges in surgical volume. Without a structured framework to collect data on health system response, we miss opportunities to identify and strengthen areas of insufficient capacity. We encourage the incorporation of quantitative surgical metrics when reporting outcomes after disaster response, and propose the 4S framework as a conceptual model for reporting such metrics and understanding the surgical system response to disasters. Funding None.

Building Bridges or Breaking Bonds? The Belt and Road Initiative and Foreign Aid Competition

China’s renewed prominence is the most important development in international relations in the 21st century. Despite longstanding rhetoric of its own “peaceful rise”, China is increasingly viewed as a long-term strategic competitor, especially in the United States. Foreign aid is one arena where this competition may be playing out. While Western foreign aid principles have emphasized coordination and harmonization, the rise of China as a major development partner has raised the specter of a return to competitive foreign aid practices. Most notably, China’s Belt and Road Initiative (BRI), has received a wary reception by some who view it primarily as a geostrategic effort. We test if the BRI is inducing a competitive foreign aid response by evaluating if countries involved in this initiative are more likely to receive US support for loan packages from the major, Western, multilateral development banks (MDBs). Using an instrumental variable approach, covering 6975 project/loan packages in 16 MDBs from 157 countries during 2013-2018 period, we find that the United States is more likely to vote for MDB packages to countries that have signed on to the BRI, predominantly when the actual amount of Chinese aid flowing to those countries is still low, suggesting the US is competing for “in play” countries.

Is Foreign Aid Responsive to Environmental Needs and Performance of Developing Countries? Case Study of the Czech Republic.

This paper examines the responsiveness of foreign aid to environmental needs and performance of developing countries using, as an example, the Czech Republic. It focuses on the environmental component of foreign aid, which is defined as the development intervention of the Czech Government, which can be expected to have positive environmental impacts in target countries. The provision of environmental aid is based on the assumption that the Czech Republic has practical, transferable experience of qualitative improvements in the environment following the collapse of communist regime. Flows of environmental aid were determined by analyzing and categorizing individual development aid projects in the period 2000 to 2015. Regression analyses were employed to explain the pattern of Czech environmental aid allocations. The results show relatively limited reflection of the recipient’s environmental needs in the distribution of Czech environmental aid. Only two environmental objectives were significantly echoed in actual aid flows. The first was transfer of advanced environmental technologies and reductions in energy consumption, approximated by carbon dioxide emissions per capita. The second was protection of biodiversity, represented by the extinction risk of sets of species. The other five objectives did not play significant roles in environmental aid allocations. Above that, other factors not related to the environmental needs and performance of recipient countries affected Czech environmental aid. Among them, historical ties to other former communist countries were of high significance. The findings call into question the environmental objectives of Czech foreign aid and point to the need for transparent criteria for the allocation of environmental aid.

Policy change and micro-politics in global health aid: HIV in South Africa.

Efforts to improve the effectiveness of global health aid rarely take full account of the micro-politics of policy change and implementation. South Africa's HIV/AIDS epidemic is a case in point, where the US President's Emergency Plan for AIDS Relief (PEPFAR) has provided essential support to the national AIDS response. With changing political context, PEPFAR has shifted focus several times-most recently reversing the policy of 'transition' out of direct aid to a policy of re-investing in front-line services in priority districts to improve aid effectiveness. However, this policy shift has not led to the expected impact on health services. This paper reports the findings of a study on the implementation of the recent policy through interviews at randomly selected sites in high HIV-burden districts of South Africa that capture the experiences of public-sector health leaders. We find little evidence to support the explanation that the new aid policy displaced government staff and resources. Instead, our findings suggest that legacies of the previous policy remained as local aid managers did not shift funding and practice at sufficient scale to drive the planned service delivery expansion. Human resource support, the main PEPFAR contribution to service delivery at front-line facilities, was not adequate or distributed based on the size of the HIV programme, leaving notable gaps in outreach, defaulter tracing, and community service delivery. Instead, services that better fit the previous policy paradigm, like training and data-sharing, are common at site-level but provide diminishing returns. Together, our findings suggest opportunities for PEPFAR South Africa to revisit its model and increase service delivery intensity, in particular through community-based services. More broadly, this case illustrates the need for greater attention to the multiple actors with discretion in the policy system of health aid and the mechanisms through which political priority is translated into programming as policy shifts are made.

The political economy of landslides and international aid relief: a qualitative investigation in rural Uganda

&lt;p&gt;This is a qualitative study of perspectives from community members on landslides in Bududa, Uganda. Interviews with community members reveal their perceptions of the causes, effects, and aid response to landslides. We employ a 'structural fieldwork' approach to explain community member's thoughts and experiences using critical macro-comparative perspectives relating to political ecology. This research brings attention to how large-scale unequal relationships in trade and international aid increase landslide vulnerability and there are ineffective relief efforts in a particular locale. Linking environmental degradation in Bududa to political, economic, and social factors provides a broader context in which to view risk from landslides in this community, as a critical case in demonstrating how economic globalization benefits some at the expense of others.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Keywords: &lt;/strong&gt;Landslides, unequal exchange, disaster, NGOs, political economy&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Civil society demand for accountability to achieve the 90-90-90 targets: lessons from Eastern and Southern Africa.

Civil society demand for accountability has long been a critical component of the AIDS response. In the age of 90-90-90 HIV treatment goals, civil society advocacy has continued, but often in new forms. In particular, civil society accountability at the intersection of national policy and global health financing has taken on increasing importance, but has not been well documented. Civil society demand for accountability is a key to addressing both the insufficient progress toward '90-90-90' HIV treatment goals and the gap in democracy in HIV policymaking particularly prevalent in the context of internationally financed HIV programming. Civil society can serve three vital functions for accountability: unlocking decision-making processes monopolized by powerful funders through North-South networks; challenging dominant ideas that justify status-quo policies; and 'venue shifting' to institutionalize new, more open spaces for policymaking. The functions of civil society demand for accountability have played key roles in improving the AIDS response in several countries in East and Southern Africa. Dramatically scaling-up capacity for civil society advocacy is necessary in the near term to achieve global HIV goals.

Assessment of knowledge, attitude, and practice about first aid among male school teachers and administrators in Riyadh, Saudi Arabia.

Background:Children are more exposed to harm and have a higher risk. Teachers are facing many circumstances of students in schools, and this needs medical attention and perception of what to do.Aim:To assess the levels of knowledge of teachers and school instructors that live in the city of Riyadh related to basic first-aid practices and some variables which influenced these levels of information.Material and Methods:In this cross-sectional study which was conducted on teachers and school instructors in Riyadh, a questionnaire containing sociodemographic properties and the level of knowledge related to first-aid practices was applied under supervision. The level of perception was evaluated on a 25-point scale. This study was approved by the King Saud University School of Medicine.Results:The mean score of knowledge about the first aid of the population was found to be 10.36. It was found that teachers who have good knowledge of first aid (≥15 out of 25 points) are 14.9% (N = 65). Also, it was found that first-aid scores of knowledge showed a significant difference in age and having received first-aid training.Conclusions:We concluded that most of the teachers show weak knowledge of first aid and inappropriate response for common emergency scenarios. Also, the teachers who have training for first aid has a higher likelihood to respond better in those given scenarios, but the majority of the sample have not received any training to deal with those scenarios. We recommend that teachers must undergo a first-aid training program.

African voices and leadership is imperative for the global AIDS response.

This position paper is written in reference to the recent extensive media coverage of the report of the Independent Panel describing Harassment, Including Sexual Harassment, Bullying and Abuse of Power at UNAIDS Secretariat by several newspapers and authoritative journals such as Science and The Lancet. Unfortunately, none of these publications provide any clear evidence to support the accusations and merely repeat what are, in our view, unsubstantiated statements made in the report. Given the critical role that Africans have played in dealing with one of the most severe epidemics that the world has seen and the gravity of these charges, we believe it is essential to reaffirm that African voices and leadership is imperative for the global AIDS response.

Acceptability of HIV self-testing in African students: a cross-sectional survey in the Democratic Republic of Congo.

IntroductionThe empowerment of young people aged 15-24 years is a key component of an effective AIDS response. HIV self-testing (HIVST) is progressively being implemented in the Democratic Republic of Congo (DRC).MethodsSocio-demographic and behavioural factors associated with acceptability of HIVST were evaluated among university students in Bunia, DRC. A representative cross-sectional study was conducted using a self-administered semi-structured questionnaire.ResultsA total of 1,012 students were recruited. Acceptability of unsupervised HIVST was higher in the group of young students as compared with older students and was markedly associated with prior knowledge on HIVST.ConclusionAdapted communication about HIVST appears likely essential to increase the supply and use of HIVST among students in DRC.

On situational factors promoting bystanders’ aid response to bullying in China

On situational factors promoting bystanders’ aid response to bullying in China

Know Your Response: Pilot Mapping of HIV Prevention Responses by Non-governmental Organizations in Southern Province, Zambia

ZAMBIA’S nation-wide adult Human Immunodeficiency virus (HIV) prevalence stood at 13.3 percent in 2014. In Southern Province, 12.8 percent of adult men and women aged 15-49 years were HIV positive. The prevalence was higher in women than in men (15.1% compared to 11.3%). The most recent data also suggested that key populations were disproportionately infected with HIV compared to the general population. The Measure Know Your Response (KYR) study took place from September 2013 to July 2014 in the Southern Province of Zambia. The aim was to map and characterize the HIV response among both government (health and none health) and non-government organizations (NGOs). The purpose was to identify gaps in the response, in particular in terms of the geographical areas and the key populations attended to and those disproportionately missed. This paper focuses on the results from the mapping of NGOs involved in HIV and AIDS response. For this aspect of the mapping data were collected using the NGO Sector Questionnaire. Focus was interventions of NGOs and their services to target populations across all the 12 districts of the Southern Province. All program implementers working in a given district were asked questions to assess the extent to which their HIV-prevention activities in the district included strategies to address all key populations, including gender issues. Data from the quantitative questionnaires was analyzed using STATA version 12.0 and Microsoft Excel. The results of the pilot test revealed gaps in both geographic spread and content of programs in the NGOs run HIV-prevention response. For instance, hardly any NGOs worked in the new and smaller districts of Pemba, Siavonga, and Zimba. Similarly, certain services, such as mass media campaigns, interpersonal education and persuasion programs were being implemented across all the districts. Further, fewer than three of the 93 organizations surveyed targeted key populations, notably sex workers, incarcerated populations, men who have sex with men (MSM), transgender people and injective drug users. With respect to gender, about 25% of the organizations did not integrate gender issues into their HIV-prevention activities. From a methodological standpoint, the pilot test revealed the need to examine dimensions of program content, quality and intensity. In spite of these limitations, the study permits us to know which interventions are being implemented by the NGO sector, contributing to new knowledge in Zambia about geographic gaps in the availability of HIV-prevention interventions.

The Danger of the Extended Hand: A Critique of Humanitarian Aid in Makenzy Orcel’s L’Ombre Animale

Since the 2010 earthquake that destroyed Port-au-Prince, there have been a number of inquiries detailing the material failures of the multi-national humanitarian aid response. Studies have focused on the misuse of funds by large international organizations, and they have attempted to trace the donations made by individuals and governments alike. Still others indicate the neocolonial manner in which Haitians were themselves cut out of negotiations regarding how their nation should be rebuilt. Such criticisms are of particular interest, given the 40,000 Haitians still living under tarps more than eight years after the quake. Despite the documented disappointments of the post-earthquake aid initiative, North Atlantic aid workers and organizations enjoy a privileged position in the collective unconscious of the global North. As is becoming increasingly clear, “Aid” often does more harm than good, whether due to oversight, greed, or the momentum of the global wealth and power disparity. Makenzy Orcel’s 2016 novel L’Ombre animale represents foreign development workers—not as the long-awaited rescuers of Haiti—but as wolves come to feed off the precarity and vulnerability of a rural Haitian village. In this article, I maintain that, through the historically and mythologically salient figure of the wolf, Orcel systematically questions the moral capital attributed to the white savior.

Validation of FAT4CP© first aid module and assessment tool: Evaluating module acceptance and the Knowledge, Attitude and Confidence (KAC) on first aid response among childcare providers

At present, there is a paucity of Malaysian policy on paediatric first aid training for childcare providers. Thus, this study has developed a first aid module called FAT4CP© for childcare providers and aim to determine the acceptance level of the module and validate an instrument that evaluates the competency of their knowledge, attitude and confidence (KAC) in conducting first aid. Focusing on the content, graphics and design, evaluation of acceptance for the module involved 15 childcare providers with at least one year of experience in handling children at childcare centres and 15 healthcare professionals. Together with the module, an assessment tool was developed, with content and face validity assessed by content experts. A self-administrated questionnaire was distributed to 70 childcare providers to measure their first aid KAC. Construct validity of the questionnaire was examined using Exploratory Factor Analysis (EFA) with principal component methods and varimax rotation. Cronbach's α values were used to estimate the reliability of the questionnaire. This study revealed that the module was well accepted with a majority of the childcare providers (93.3%, n=14) indicated that they understood the information contained in the module. The first aid assessment tool was also found to be reliable in measuring knowledge, attitude and confidence among childcare providers with Cronbach's alpha of 0.56, 0.95 and 0.92, respectively. For content validity, the questionnaires were critically reviewed in terms of relevance, clarity, simplicity, and ambiguity. In conclusion, the findings of this study demonstrated that the module was well received, and the assessment tool is valid and reliable in measuring first aid KAC among childcare providers.

The Homestay Phenomenon: Expedient Homes in the Majestic Cordillera Highlands

Utilizing combination of quantitative and qualitative research approaches using the techniques of survey, open-ended questions and interviews, this study aimed to: (a) describe Batad’s geographical location and ecotourism attractions; (b) analyze Batad’s Homestay as a potential economic driver to boost local tourism efforts; (c) identify current enablers as well as challenges of the homestay industry; and (d) propose relevant recommendations to ensure the sustainability of the homestay industry. Results revealed that Batad is one of the 18 barangays of the municipality of Banaue, province of Ifugao, Philippines. It is famous for its amphitheater-like rice terraces, one of the five clusters of rice terraces in Ifugao that was inscribed in the 1995 UNESCO World Heritage Site list. This once isolated farming community is steadily transforming itself into a tourism community. It was found that some local attractions in Batad consist of: (a) Batad’s Rice Terraces resembling an amphitheater; (b) the Tappiyah Waterfalls; (c) the Awa view; (d) Sitio Patpat; (e) Batad’s Traditional Ifugao huts; and (f) Batad’s Socio-Cultural Activities. The homestay owners were dominated by female entrepreneurs, in their middle adulthood and were mostly Batad residents. Most homestays have limited staff as the homestay industry was only a part time source of income. Capacitation trainings mostly consisted of first aid or emergency response trainings, front office, social etiquettes, banquet and housekeeping. Some enabling mechanisms comprised: continuing presence of local and foreign tourists; global, national and local presence or efforts to preserve the rice terraces; infrastructural project especially the paving of roads that lead to Batad and electrification; national and local environmental education programs; rich ecotourism sites; and capacitation or assistance extended by local and national agencies. Some challenges comprised: limited contribution in community environmental education awareness; limited representation in tourism development; lacked of internet, cell phone and television signals; inadequate marketing strategies; inexperienced homestay staff; lack of waste disposal and drainage; continuing professionalization of staff; how to create unique brand image; and inadequate financial support for farmers to sustain the rice terraces.

Same-sex lives between the language of international LGBT rights, international aid, and anti-homosexuality

This article considers how international development aid is used in engaging with sexuality rights in Africa. It considers both the emergence of lesbian, gay, bisexual, and transgender (LGBT) rights as aid conditionality in international aid relations and responses to these from African political leaders. The central issue identified is that political leaders for and against these rights have marginalized and ignored voices of the sexually diverse people in their engagements in African settings. Here, a problem emerges that people’s own claims for rights are subsumed within the broader agendas set by politicians at international and national levels. This article analyzes these relations and their outcomes for activists and civil society groups in diverse African settings by considering the language of LGBT rights used by international political actors and the ways in which African political leaders develop their own language on the issue.

Outdoor Thermal Comfort during Anomalous Heat at the 2015 Pan American Games in Toronto, Canada

Mass sporting events in the summertime are influenced by underlying weather patterns, with high temperatures posing a risk for spectators and athletes alike. To better understand weather variations in the Greater Toronto Area (GTA) during the Pan American Games in 2015 (PA15 Games), Environment and Climate Change Canada deployed a mesoscale monitoring network system of 53 weather stations. Spatial maps across the GTA demonstrate large variations by heat metric (e.g., maximum temperature, humidex, and wet bulb globe temperature), identifying Hamilton, Ontario as an area of elevated heat and humidity, and hence risk for heat-related illness. A case study of the Hamilton Soccer Center examined on-site thermal comfort during a heat event and PA15 Soccer Games, demonstrating that athletes and spectators were faced with thermal discomfort and a heightened risk of heat-related illness. Results are corroborated by First Aid and emergency response data during the events, as well as insight from personal experiences and Twitter feed. Integrating these results provides new information on potential benefits to society from utilizing mesonet systems during large-scale sporting events. Results further improve our understanding of intra-urban heat variability and heat-health burden. The benefits of utilizing more comprehensive modeling approaches for human heat stress that coincide with fine-scale weather information are discussed.

Impacts of anthropogenic and natural “extreme events” on global fisheries

AbstractA broad range of extreme events can affect fisheries catch and hence performance. Using a compiled database of extreme events for all maritime countries in the world between 1950 to 2010, we estimate effects on national fisheries catches, by sector, large‐scale industrial and small scale (artisanal, subsistence and recreational). Contrary to general expectations, fisheries catches respond positively to nearly all forms of extreme events, suggesting a valuable coping or compensation mechanism for coastal communities as they increase their catch after extreme events, but also an opportunistic behaviour by foreign industrial fishing fleets, as industrial catches increase. These effects vary according to country characteristics, with lower coping capacity for coastal communities and higher opportunistic fishing by foreign fleets in countries with poor governance, higher unemployment and direct exposure to prolonged armed conflicts. We also observe an accumulative effect resulting from the aggregation of multiple disasters that deserves further consideration for disaster mitigation. These findings may assist with managing fisheries towards increasing resilience and adaptive capacity such as early detection of potential impacts, protecting livelihoods and food sources, preventing illegal fishing by industrial fleets and informing aid responses towards recovery.