Purpose: To: (a) identify risk and protective factors for behaviors that expose Zambian youth to risk of HIV infection and, (b) assess whether research findings from the United States concerning ...protective factors in “high-risk” environments might apply to other settings.
Methods: A community-based sample of 2328 youth ages 10–24 years residing in Lusaka, Zambia was interviewed. Multivariate statistical methods were used to isolate risk and protective factors for selected sexual and contraceptive behaviors. Seven categories of factors were considered: sociodemographic factors, sexual-reproductive health knowledge and perceptions, nonsexual risk behaviors, peer influence, connections with parents and social institutions, and communication with sexual partners.
Results: A sizeable number of factors were associated with each outcome. Only two factors, school attendance and knowledge of AIDS, were associated with both lower levels of sexual activity and consistent use of condoms, and only engaging in higher-risk social activities with close friends was a risk factor for both. The effects of the other factors considered varied by outcome and gender. As in prior research, strong influences of peers were observed, but connections with parents and social institutions unexpectedly did not emerge as protective.
Conclusion: Because of the number and diverse nature of factors influencing adolescent behaviors, it is unlikely that a single intervention will be found to immediately change sexual risk-taking behaviors in Zambia.
We examine the emergence, development, and value of regional infectious disease surveillance networks that neighboring countries worldwide are organizing to control cross-border outbreaks at their ...source. The regional perspective represented in the paper is intended to serve as an instructive framework for others who decide to launch such networks as new technologies and emerging threats bring countries even closer together. Distinct from more formal networks in geographic regions designated by the World Health Organization (WHO), these networks usually involve groupings of fewer countries chosen by national governments to optimize surveillance efforts. Sometimes referred to as sub-regional, these "self-organizing" networks complement national and local government recognition with informal relationships across borders among epidemiologists, scientists, ministry officials, health workers, border officers, and community members. Their development over time reflects both incremental learning and growing connections among network actors; and changing disease patterns, with infectious disease threats shifting over time from local to regional to global levels. Not only has this regional disease surveillance network model expanded across the globe, it has also expanded from a mostly practitioner-based network model to one that covers training, capacity-building, and multidisciplinary research. Today, several of these networks are linked through Connecting Organizations for Regional Disease Surveillance (CORDS). We explore how regional disease surveillance networks add value to global disease detection and response by complementing other systems and efforts, by harnessing their power to achieve other goals such as health and human security, and by helping countries adapt to complex challenges via multi-sectoral solutions. We note that governmental commitment and trust among participating individuals are critical to the success of regional infectious disease surveillance networks.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The Mekong Basin Disease Surveillance (MBDS) network was formally established in 2001 through a Memorandum of Understanding signed by six Ministers of Health of the countries in the Greater Mekong ...sub-region: Cambodia, China (Yunnan and Guangxi), Lao PDR, Myanmar, Thailand and Vietnam. The main areas of focus of the network are to: i) improve cross-border infectious disease outbreak investigation and response by sharing surveillance data and best practices in disease recognition and reporting, and by jointly responding to outbreaks; ii) develop expertise in epidemiological surveillance across the countries; and iii) enhance communication between the countries. Comprised of senior health officials, epidemiologists, health practitioners, and other professionals, the MBDS has grown and matured over the years into an entity based on mutual trust that can be sustained into the future. Other regions have started emulating the network's pioneering work. In this paper, we describe the development of MBDS, the way in which it operates today, and some of its achievements. We present key challenges the network has faced and lessons its members have learned about how to develop sufficient trust for health and other professionals to alert each other to disease threats across national borders and thereby more effectively combat these threats.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The globalization of trade and travel has led to the globalization of communicable diseases and, in turn, increased need for globalization of solutions to fight them. The self-organized regional ...disease surveillance networks described in this special issue of Emerging Health Threats are one such solution. They reflect the vision, commitment and leadership of country health leaders and their development partners (1-4). The networks described here are significantly different from and complementary to regional surveillance systems of the World Health Organization (WHO), World Organization for Animal Health (OIE) and Food and Agriculture Organization (FAO) (5, 6). Citation: Emerg Health Threats J 2013, 6: 19961 - http://dx.doi.org/10.3402/ehtj.v6i0.19961
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This article summarizes the observations and lessons learned regarding the application of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), prevention and reproductive ...health evaluation methodologies in the context of adolescent and young adult populations and discusses the use of peer network evaluation to understand the dynamics of peer promotion. To examine the interpersonal communication process of peer education, this study tested a new approach using multiple semistructured interviews and network analysis to collect data on 106 peer educators and 526 of their contacts. These evaluation activities were conducted at three sites in Ghana during April 1998, in both periurban and rural locations in both in-school and out-of-school settings. By evaluating the social networks of peer educators it was possible to gain a better understanding of the process of peer education in terms of (a) defining the composition of peer contacts, (b) identifying the social norms that play a critical role in youth decision making, and (c) observing the range of messages and services transmitted during peer education. The objective of this paper is to disseminate the experience of the Center for Education and Development of Population Activities (CEDPA) and Focus on Young Adult's cooperative development of evaluation methodologies for peer promotion and to highlight utilization of these methodologies in a case study in Ghana. The results will be discussed in terms of their possible implications for program managers, researchers, and international agencies.
Prevention approaches for reproductive health have evolved from an emphasis on individually focused models of behavior change to a recognition that risk reduction occurs within a context of social ...norms. Prevention programs can be improved by understanding how social structure influences sexual behavior and using that understanding to develop strategies for positive change. In a dynamic, urban context, communities are better conceptualized as informal networks of ties. These network structures may help to protect, or conversely, expose members to reproductive risk behaviors. Using data from a study of social and sexual networks conducted in northern Thailand, this article describes partner relations and social structure in the modern, urban context, and illustrates the links between individual, relational and structural properties and reproductive risk behaviors. Triangulation of ethnographic, survey and social network data collection and analytic tools provide an opportunity to interpret individual behaviors, meanings of relationships and structural properties of networks. Intervention approaches should build on existing networks, and address the complex meanings of romantic and sexual partnerships.
In February 2014, health officials from around the world announced the Global Health Security Agenda, a critical effort to strengthen national and global systems to prevent, detect, and respond to ...infectious disease threats and to foster stronger collaboration across borders. With its increasing global roles and broad range of regulatory responsibilities in ensuring the availability, safety, and security of medical and food products, the US Food and Drug Administration (FDA) is engaged in a range of efforts in support of global health security. This article provides an overview of FDA's global health security roles, focusing on its responsibilities related to the development and use of medical countermeasures (MCMs) for preventing, detecting, and responding to global infectious disease and other public health emergency threats. The article also discusses several areas-antimicrobial resistance, food safety, and supply chain integrity-in which FDA's global health security roles continue to evolve and extend beyond MCMs and, in some cases, beyond traditional infectious disease threats.
Context: In Ghana, as in many other Sub-Saharan African countries, the behaviors of the current cohort of adolescents will strongly influence the course of the HIV/AIDS epidemic. This study sought to ...identify factors associated with elevated risks of pregnancy and sexually transmitted infection among unmarried Ghanaian youth. Methods: A nationally representative sample of 3,739 unmarried 12-24-year-olds were surveyed. Various regression techniques were used to assess the effects of individual and contextual factors on sexual behavior and condom use. Results: Forty-one percent of female and 36% of male youth reported being sexually experienced. On average, sexually experienced youth had had fewer than two partners; only 4% of these females and 11% of males had had more than one sexual partner in the three months before the survey. Although Ghanaian youth are knowledgeable about condoms, only 24% of sexually experienced males and 20% of females reported consistent condom use with their current or most recent partner. A sizable number of contextual factors and attributes of youth themselves were associated with sexual behaviors, while individual characteristics were stronger predictors of condom use. Conclusions: The findings provide further justification for interventions targeting key contextual factors that influence youth behaviors in addition to providing youth with necessary communication, negotiation and other life skills. /// Spanish Contexto: En Ghana, al igual que en muchos otros países del África Subsahariana, la conducta de la actual generatión de adolescentes tendrá una gran influencia en la propagatión de la epidemia del VIH-SIDA. Este estudio procuró identificar los factores relacionados con los elevados riesgos de embarazo y de infecciones transmitidas sexualmente entre los jóvenes no casados de ese país. Métodos: Se realizó una encuesta a nivel national con una muestra de 3.739 jóvenes no casados de 12-24 años de edad. Se utilizaron varias técnicas de análisis de regresión para evaluar los efectos de los factores individuales y de contexto con respecto a las conductas sexuales y el uso del condón. Resultados: El 41% de las mujeres y el 36% de los hombres indicaron que tenían experiencia sexual. En promedio, los que tenían experiencia sexual habían tenido relaciones con menos de dos parejas; solamente el 4% de estas mujeres y el 11% de dichos hombres habían tenido más de una pareja sexual durante los tres meses previos a la encuesta. Si bien los jóvenes de Ghana tienen conocimiento del condón, solamente el 24% de los hombres con experiencia sexual y el 20% de las mujeres con experiencia indicaron que habían utilizado el condón en cada acto sexual con su pareja actual o con su pareja más reciente. Un importante número de factores de contexto y de atributos de los propios jóvenes estuvieron relacionados con la conducta sexual, en tanto que las características individuales resultaron sólidas variables predictivas del uso del condón. Conclusiones: Los resultados indican que se justifica centrar la atención en actividades dirigidas a intervenir en factores de contexto claves que influyen en la conducta de los jóvenes, además de ofrecerles entrenamiento en las áreas de comunicación, negociación y las herramientas necesarias para la vida. /// French Contexte: Au Ghana, comme dans de nombreux autres pays d'Afrique subsaharienne, les comportements de la cohorte d'adolescents d'aujourd'hui influenceront largement le cours de l'épidémie du VIH/SIDA. Cette étude cherche à identifier les facteurs associés aux risques élevés de grossesse et d'infection sexuellement transmissible chez les jeunes Ghanéens célibataires. Méthodes: Un échantillon nationalement représentatif de 3.739 célibataires de 12 à 24 ans a été soumis à l'enquête. Les effets des facteurs individuels et contextuels sur le comportement sexuel et l'usage du préservatif ont été évalués par différentes techniques de régression. Résultats: Quarante et un pour cent des jeunes femmes et 36% des jeunes hommes ont déclaré être sexuellement expérimentés. En moyenne, ces jeunes avaient eu moins de deux partenaires; 4% seulement des filles et 11% des garçons avaient eu plus d'un(e) partenaire sexuel(le) durant les trois mois précédant l'enquête. Malgré la connaissance qu'ont les jeunes Ghanéens du préservatif, 24% seulement des garçons sexuellement expérimentés et 20% des filles ont déclaré un usage régulier de la méthode avec leur partenaire actuel(le) ou le (la) plus récent(e). Un nombre considérable de facteurs contextuels et attributs des jeunes eux-mêmes a été associé aux comportements sexuels, tandis que les caractéristiques individuelles se révélaient de plus forts prédicteurs d'usage du préservatif. Conclusions: Les conclusions de l'étude renforcent la justification d'interventions ciblées sur les facteurs contextuels clés d'influence des comportements des jeunes, en plus de l'apport aux jeunes des compétences nécessaires de communication, négociation et autres aspects de savoir-être.
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