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The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics. Motives for discontinuation reflect findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

The objective of this study is to explore selected pharmacies' readiness to serve women seeking emergency contraception (EC). This study used a mystery client (MC) methodology to visit 73 pharmacies in Kinshasa, Democratic Republic of Congo (DRC). Findings indicate that more than two-thirds of EC providers were knowledgeable about EC dosage, timeframe, and side effects, and 90% were deemed helpful towards novice EC users. Rare but glaring misconceptions about EC timeframe (20% of providers) and long-term side effects (4% of providers), as well as frequent stock-out (22%) and cost issues highlight priorities for programmatic improvements. As new service delivery strategies are explored to complement the uneven network of health structures in DRC, this study suggests that, given proper training and integration in FP programming, private-sector pharmacies have the potential to meet specific contraceptive needs for women living in Kinshasa.

In Gavi-eligible countries partnerships are dynamic networks of immunization actors who work together to support all stages and aspects of Gavi support. This paper describes a conceptual framework--the partnership framework--and analytic approach for evaluating the perceptions of partnerships’ value as well as the results from an application to one case in Uganda. We used a mixed-methods case study design embedded in the Gavi Full Country Evaluations to test the partnership framework on Uganda’s human papillomavirus vaccine application partnership. The partnership was not perceived to have increased the efficiency of the process, perhaps as a result of unclear or absent guidelines around roles and responsibilities. We concluded that the health and functioning of global health partnerships can be evaluated using the framework and approach presented here. Network theory and methods added value to the conceptual and analytic processes, and we recommend applying this approach to other global health partnerships to ensure that they are meeting the complex challenges they were designed to address.

Kobe Refugee camp hosts roughly 39,000 refugees displaced from Somalia during the 2011–2012 Horn of Africa Crisis. Sexual and reproductive health (SRH) issues, as well as the greater issues of health and well-being for adolescents displaced from this crisis, remain largely unknown and neglected. In 2013, the Women’s Refugee Commission, Johns Hopkins University, and International Medical Corps in Ethiopia implemented qualitative and quantitative research to explore the factors and risks that impact the health of very young adolescents (VYAs), those 10–14 years of age, in this setting. This research identified several factors that were found to influence the health and well-being of VYAs in Kobe refugee camp, including newfound access to education and security, combined with gender divisions and parental communication around early SRH and puberty that remained intact from traditional Somali culture. Girls were found to face an additional risk of child marriage and early pregnancy since displacement, which significantly limited their ability to access education and achieve future aspirations.

Bedaquiline (BDQ) has been recommended by the World Health Organization for the treatment of multidrug-resistant tuberculosis (MDR-TB) since 2013, but experience using the drug in high-burden, lower-income countries is limited and case studies are needed. Swaziland started using BDQ under national TB programme conditions in 2015 in four pilot sites. As of 1 December 2016, 93 patients had been initiated on BDQ, i.e., 19% of MDR-TB patients treated in the country. Swaziland has developed a systematic and efficient model for BDQ introduction in collaboration with several partners. This model is also being used to introduce other innovations and can serve as an example for other countries facing similar challenges.

We interviewed 273 HIV-infected adolescents receiving antiretroviral therapy (ART) from three hospitals in Addis Ababa. The level of self-reported ART adherence among HIV-infected adolescents at the three hospitals was below the recommended threshold. Though earlier presentation of adolescents to care should be encouraged, more targeted adherence support should be planned for those who present at an early stage of their illness.

Access to safe and effective family planning is a fundamental human right, essential for achieving gender equality, eliminating extreme poverty, and reducing maternal and child deaths.

Despite challenges of operating in emergency settings, the South Sudan Challenge TB project has been able to support improvements in case notification and other TB-related indicators. This technical highlight showcases implementation strategies, results, lessons, and reflections on the way forward.

The world loses 300,000 women and nearly 5 million children to preventable causes each year. Millions of women in low-resource settings lack proper antenatal care, give birth without a skilled attendant, and don't receive postpartum care.

Once an outbreak becomes an epidemic, the costs - both human and financial - on health systems are extensive and debilitating. 

The list of 10 Core tests in each country includes six testing methods selected according to the International Health Regulations' immediately notifiable list and the WHO Top Ten Causes of Death in low-income countries. 

The Global Health Security Agenda (GHSA) was launched in February 2014 to help build countries’ capacity to help create a world safe and secure from infectious disease threats and elevate global health security as a national and global priority. Find out more about the GHSA Action Packages, visit: https://www.ghsagenda.org/ 

The Global Health Security Agenda (GHSA) was launched in February 2014 to help build countries’ capacity to help create a world safe and secure from infectious disease threats and elevate global health security as a national and global priority. Find out more about the GHSA, visit: https://www.ghsagenda.org/ 

Over half a billion people have died in epidemics over the last century and most experts agree another epidemic is not a matter of if, but a matter of when. Are you ready? This one page summary of Ready Together was presented at the 2017 Conference on Epidemic Preparedness held at Harvard Medical School.  

Between May and July of 2015, South Korea experienced an outbreak of Middle East respiratory syndrome, or MERS, that lead to 38 deaths and seriously affected the country's economy. 

The No More Epidemics campaign held its final event on November 13, 2017—the Ready Together Conference on Epidemic Preparedness, hosted in partnership with Harvard Medical School, Georgetown University’s Center for Global Health Science and Security, Harvard Global Health Institute, and the James M. and Cathleen D. Stone Foundation.

This 4-page brochure on health systems strengthening describes how MSH partners with countries to build strong, resilient, sustainable health systems that can deliver universal health coverage—equitable, affordable access to high-quality health services for all who need them.

In his new book, 'The End of Epidemics: The Looming Threat to Humanity and How to Stop It,' Dr. Johnathan D. Quick, a Harvard Medical School faculty member and Chair of the Global Health Council, examines the eradication of smallpox and devastating effects of influenza, AIDS, SARS, and Ebola.

Between December 2014 and September 2016, we conducted a prospective cohort study in eight health facilities in Ethiopia. Eligibility criteria included age 3 months-14 years; being on ART for not more than a month. Of 309 children, 304 were included, 52% were male. During 287.7 person-years of observation (PYO), 24 attritions were recorded, yielding an attrition rate of 8.3 per 100 PYO. Younger children, those from rural areas, and children with anaemia were at higher risk of attrition, especially during the early months of treatment, and therefore should be prioritized during treatment follow-up.

This was a retrospective study of TB data for Kampala City for the period 2011–2015. We extracted data from the TB registers in the 52 diagnostic and treatment units in Kampala. We report on data for children 0 to 14 years. We accessed 33,221 TB patient records, of which 2,333 (7%) were children. The proportion of children with pulmonary TB was 80%. The TB notification rate among children in Kampala City showed a large decline (from 105 to 74 per 100,000) during the period. There was a slight improvement in the treatment success rate among the children.

Clinical monitoring of pediatric HIV treatment remains a major challenge in settings where drug resistance genotyping is not routinely available. As a result, our understanding of drug resistance, and its impact on subsequent therapeutic regimens available in these settings, remains limited. We investigate the prevalence and correlates of HIV-1 drug resistance among 94 participants of the Ethiopia Pediatric HIV Cohort failing first-line combination antiretroviral therapy (cART) using dried blood spot-based genotyping. Overall, 81% (73/90) of successfully genotyped participants harbored resistance mutations. Strikingly, 42% of resistant participants harbored resistance to all four nucleoside reverse transcriptase inhibitors recommended for second-line use in this setting, meaning that there are effectively no remaining cART options for these children. Longer cART duration and prior regimen changes were significantly associated with detection of drug resistance mutations. Replicate genotyping increased the breadth of drug resistance detected in 34% of cases, and thus is recommended for consideration when typing from blood spots. Implementation of timely drug resistance testing and access to newer antiretrovirals and drug classes are urgently needed to guide clinical decision-making and improve outcomes for HIV-infected children on first-line cART in Ethiopia.

Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting and obstructing sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia.

In 2017, with funding by UK Aid from the British people, Management Sciences for Health (MSH) launched the Lea Mimba project to address gaps in the quality of antenatal care (ANC) and to support women's and adolescents' use of maternal and newborn health services in Kakamega County, Kenya.

Outbreaks can overwhelm weak or fragile health systems that lack the tools, infrastructure, policies, and systems to keep communities healthy and safe. Timely detection, preparedness, and appropriate response are essential for limiting both the loss of human life and crippling political and socio-economic impact of disease outbreaks.

A civil society organisation (CSO) perspective on how UHC can be reached by 2030 Universal Health Coverage 2030 (UHC2030) MSH is the secretariat for the Civil Society Engagement Mechanism of UHC2030, a global movement to build stronger health systems for universal health coverage.

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