| 1. |
- Bergström, Anna, et al.
(författare)
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Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings
- 2015
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Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.
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| 2. |
- Contreras, Mariela, 1979-, et al.
(författare)
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Consumption of highly processed snacks, sugar-sweetened beverages and child feeding practices in a rural area of Nicaragua
- 2016
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Ingår i: Maternal and Child Nutrition. - : Wiley. - 1740-8695 .- 1740-8709. ; 12:1, s. 164-176
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Tidskriftsartikel (refereegranskat)abstract
- Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar-sweetened beverages (SSBs). All households with at least one child 0- to 35-month-old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0- to 1-month-olds and continued to be prevalent (60%) in the second year, while only 34% of the 0- to 5-month-olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6- to 11-month-old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6- to 8-month-olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long-term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.
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| 3. |
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| 4. |
- Contreras, Mariela, 1979-, et al.
(författare)
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Socio-economic resources, young child feeding practices, consumption of highly processed snacks and sugar-sweetened beverages : a population-based survey in rural northwestern Nicaragua
- 2015
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Socio-economic resources may be associated with infant feeding in complex patterns in societies undergoing a nutrition transition. This study evaluates associations of housing quality, food security and maternal education to the World Health Organization (WHO) feeding recommendations and to consumption of highly processed snacks (HP snacks) and sugar-sweetened beverages (SSBs) in rural Nicaragua. Methods: Data were collected from May to November 2009, with mothers of 0- to 35-month-olds being asked about young child feeding using a food frequency questionnaire. A validated questionnaire was used to assess household food insecurity and data were collected on maternal education and housing quality. Pearson's chi-squared test was used to compare proportions and determine associations between the resources and young child feeding. The three socio-economic resources and other confounders were introduced to multivariate logistic regression analyses to assess the independent contribution of the resources to the feeding practices and consumption of HP snacks and SSBs. Results: Mothers with the lowest education level were more likely to be exclusively breastfeeding (EBF) their infants (OR not EBF: 0.19; 95% CI: 0.07, 0.51), whilst mothers of 6- to 35-month-olds in the lowest education category had more inadequate dietary diversity (DD) (OR for not meet DD: 2.04; 95% CI: 1.36, 3.08), were less likely to consume HP snacks (OR for HP snacks: 0.47; 95% CI: 0.32, 0.68) and SSBs (OR for SSBs: 0.68; 95% CI: 0.46, 0.98), compared to mothers with the highest level of education. Similarly, children residing in households with the highest food insecurity were also more prone to have inadequate dietary diversity (OR for not meet DD: 1.47; 95% CI: 1.05, 2.05). The odds for double burden of suboptimal feeding (concurrent inadequate diet and consumption of HP snacks/SSBs) were significantly lower in children of least educated mothers (OR: 0.64; 95% CI: 0.44, 0.92). Conclusions: Higher level of education was associated with both more and less adherence to the WHO recommended feeding practices as well as with more consumption of HP snacks and SSBs. Regardless of educational strata, the children in the community were exposed to suboptimal feeding practices conducive to both under-as well as overnutrition.
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| 5. |
- Källestål, Carina, 1954-, et al.
(författare)
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Assessing the Multiple Dimensions of Poverty : Data Mining Approaches to the 2004-14 Health and Demographic Surveillance System in Cuatro Santos, Nicaragua
- 2020
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Ingår i: Frontiers In Public Health. - : FRONTIERS MEDIA SA. - 2296-2565. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- We identified clusters of multiple dimensions of poverty according to the capability approach theory by applying data mining approaches to the Cuatro Santos Health and Demographic Surveillance database, Nicaragua. Four municipalities in northern Nicaragua constitute the Cuatro Santos area, with 25,893 inhabitants in 5,966 households (2014). A local process analyzing poverty-related problems, prioritizing suggested actions, was initiated in 1997 and generated a community action plan 2002-2015. Interventions were school breakfasts, environmental protection, water and sanitation, preventive healthcare, home gardening, microcredit, technical training, university education stipends, and use of the Internet. In 2004, a survey of basic health and demographic information was performed in the whole population, followed by surveillance updates in 2007, 2009, and 2014 linking households and individuals. Information included the house material (floor, walls) and services (water, sanitation, electricity) as well as demographic data (birth, deaths, migration). Data on participation in interventions, food security, household assets, and women's self-rated health were collected in 2014. A K-means algorithm was used to cluster the household data (56 variables) in six clusters. The poverty ranking of household clusters using the unsatisfied basic needs index variables changed when including variables describing basic capabilities. The households in the fairly rich cluster with assets such as motorbikes and computers were described as modern. Those in the fairly poor cluster, having different degrees of food insecurity, were labeled vulnerable. Poor and poorest clusters of households were traditional, e.g., in using horses for transport. Results displayed a society transforming from traditional to modern, where the forerunners were not the richest but educated, had more working members in household, had fewer children, and were food secure. Those lagging were the poor, traditional, and food insecure. The approach may be useful for an improved understanding of poverty and to direct local policy and interventions.
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| 6. |
- Pérez, Wilton, et al.
(författare)
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Community development actions to achieve the Millennium Development Goals : An analysis based on a surveillance site in Cuatro Santos, Nicaragua
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundAccording to preliminary data, the remote rural area of Cuatro Santos, Nicaragua has shown improvements in almost all Millennium Development Goals (MDG), while a set of interventions have been running in the area. This study describes the progress toward a set of MDG, as well as the geographical disparities encountered in reaching MDG1.MethodsWe investigated selected MDG prospectively and retrospectively in 2004 and 2009, and prepared a descriptive analysis of MDG and community interventions by proportions, rates, and ratios. In order to determine any geographical disparities in progress toward MDG1 among the households receiving interventions, we used a spatial scan test (SaTScan®) to identify unique non-random spatial clusters of poverty and interventions, and a retrospective model to identify multiple clusters in a defined geographic area. Multinomial logistic regression analyses were also performed to examine the participation of single interventions on the poverty clusters that were identified by the spatial cluster analysis technique.ResultsDescriptive analysis indicated that poverty and under-five mortality declined in Cuatro Santos. Education showed no wide inequality by gender. Access to drinking water and sanitation has risen, but is not universal. Spatial analyses identified a sizeable cluster of poor households located in the northeast part of Cuatro Santos with a high probability of receiving one or more intervention. However, none reached this area. More detailed analyses of the relations between the single interventions and the poverty clusters showed that almost all interventions were positively related to the low poverty clusters (OR > 1), and negatively connected to the high-poverty clusters (OR > 1).ConclusionsThe Cuatro Santos area of Nicaragua has reached several millennium targets, and scaling up of community actions has accelerated the trend towards fulfilling MDG without increasing inequality. However, a geographical analysis reveals that areas of high poverty barely reached by interventions remain. Therefore, continuous surveillance is important to prioritize segments of the population with more social needs.
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| 7. |
- Pérez, Wilton, 1979-, et al.
(författare)
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Comparing progress toward the child mortality Millennium Development Goal in León and Cuatro Santos, Nicaragua, 1990–2008
- 2014
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 14, s. 9-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Social inequality in child survival hampers the achievement of Millennium Development Goal 4 (MDG4). Monitoring under-five mortality in different social strata may contribute to public health policies that strive to reduce social inequalities. This population-based study examines the trends, causes, and social inequality of mortality before the age of five years in rural and urban areas in Nicaragua. Methods: The study was conducted in one rural (Cuatro Santos) and one urban/rural area (Leon) based on data from Health and Demographic Surveillance Systems. We analyzed live births from 1990 to 2005 in the urban/rural area and from 1990 to 2008 in the rural area. The annual average rate reduction (AARR) and social under-five mortality inequality were calculated using the education level of the mother as a proxy for socio-economic position. Causes of child death were based on systematic interviews (verbal autopsy). Results: Under-five mortality in all areas is declining at a rate sufficient to achieve MDG4 by 2015. Urban Leon showed greater reduction (AARR = 8.5%) in mortality and inequality than rural Leon (AARR = 4.5%) or Cuatro Santos (AARR = 5.4%). Social inequality in mortality had increased in rural Leon and no improvement in survival was observed among mothers who had not completed primary school. However, the poor and remote rural area Cuatro Santos was on track to reach MDG4 with equitable child survival. Most of the deaths in both areas were due to neonatal conditions and infectious diseases. Conclusions: All rural and urban areas in Nicaragua included in this study were on track to reach MDG4, but social stratification in child survival showed different patterns; unfavorable patterns with increasing inequity in the peri-urban rural zone and a more equitable development in the urban as well as the poor and remote rural area. An equitable progress in child survival may also be accelerated in very poor settings.
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| 8. |
- Perez, Wilton, 1979-, et al.
(författare)
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Progress towards millennium development goal 1 in northern rural Nicaragua : Findings from a health and demographic surveillance site
- 2012
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Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Millennium Development Goal 1 encourages local initiatives for the eradication of extreme poverty. However, monitoring is indispensable to insure that actions performed at higher policy levels attain success. Poverty in rural areas in low- and middle-income countries remains chronic. Nevertheless, a rural area (Cuatro Santos) in northern Nicaragua has made substantial progress toward poverty eradication by 2015. We examined the level of poverty there and described interventions aimed at reducing it.METHODS:Household data collected from a Health and Demographic Surveillance System was used to analyze poverty and the transition out of it, as well as background information on family members. In the follow-up, information about specific interventions (i.e., installation of piped drinking water, latrines, access to microcredit, home gardening, and technical education) linked them to the demographic data. A propensity score was used to measure the association between the interventions and the resulting transition from poverty.RESULTS: Between 2004 and 2009, poverty was reduced as a number of interventions increased. Although microcredit was inequitably distributed across the population, combined with home gardening and technical training, it resulted in significant poverty reduction in this rural area.CONCLUSIONS:Sustainable interventions reduced poverty in the rural areas studied by about one- third.
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| 9. |
- Pérez, Wilton, 1979-, et al.
(författare)
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Trends and factors related to adolescent pregnancies : an incidence trend and conditional inference trees analysis of northern Nicaragua demographic surveillance data
- 2021
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We aimed to identify the 2001-2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20-24-year-old women.METHODS: A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004-2014 data on women aged 15-19 and 20-24. To calculate adolescent birth and pregnancy rates, we used the first live birth at ages 10-14 and 15-19 years reported by women aged 15-19 and 20-24 years, respectively, along with estimates of annual incidence rates reported by women aged 20-24 years. We conducted conditional inference tree analyses using 52 variables to identify characteristics associated with adolescent pregnancies.RESULTS: The number of first live births reported by women aged 20-24 years was 361 during the study period. Adolescent pregnancies and live births decreased from 2004 to 2009 and thereafter increased up to 2014. The adolescent pregnancy incidence (persons-years) trend dropped from 2001 (75.1 per 1000) to 2007 (27.2 per 1000), followed by a steep upward trend from 2007 to 2008 (19.1 per 1000) that increased in 2013 (26.5 per 1000). Associated factors with adolescent pregnancy were living in low-education households, where most adults in the household were working, and high proportion of adolescent pregnancies in the local community. Wealth was not linked to teenage pregnancies.CONCLUSIONS: Interventions to prevent adolescent pregnancy are imperative and must bear into account the context that influences the culture of early motherhood and lead to socioeconomic and health gains in resource-poor settings.
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| 10. |
- Zelaya Blandon, Elmer
(författare)
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Adolescent pregnancies in Nicaragua. The importance of education
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early adolescent pregnancy implies increased social and medical risks. There is lack of understanding of the mechanisms behind early sexual debut and pregnancy. This contributes to the difficulties to meet the educational and health care needs of adolescents. In Nicaragua, few reproductive health interventions target adolescents and even fewer studies focus on sexual and reproductive health in this age group. Therefore, the aim of this thesis is to analyze the background of adolescent pregnancy in Nicaragua, for future interventions.Focus group discussions and in-depth interviews were carried out with young and adult women and men from different social backgrounds in the city of León. Results were used in the planning of a cross-sectional household study carried out in 1993, covering a population of 43,765 in 50 randomly selected clusters in rural and urban León. Reproductive histories were obtained from all women aged 15 to 49 years (n= 10,867), corresponding to 176281 person years of reproductive life. Random sub-samples of men (n=388) and women (n=413) were interviewed in privacy about their age at sexual debut, contraceptive use and reproductive history. The background to early adolescent pregnancy was further analyzed in a matched case-referent study of girls who got their first pregnancy before 17 years of age (146 cases, 242 randomly selected age-matched referents).Economic deprivation and disturbed family relations with an unsatisfied craving for parental affection influence adolescent sexual behavior. Girls' romanticism, belief in virginity until marriage and the contrasting male machismo culture contribute to a lack of empowerment of adolescents.At 15 years of age, 25% of boys and girls had had their sexual debut, and at 18 years this was the case for 85% of boys and 53% of girls. Among girls, the latency period from sexual debut to the end of first pregnancy was only 22 months, indicating very limited access to contraceptive counseling and services. At 17 years of age, one fourth had become pregnant. Contraceptive use was 54% among sexually active adolescents, aged 15-19 years, pills being the most common method. Among adults, female sterilization was the most common method, followed by Intra Uterine Device (IUD) and pilL Condom use was low as well as the use of traditional methods. Low educational attainment was a strong determinant for lack of contraception.Age at sexual debut and age at first pregnancy had been increasing, and fertility rate had declined in Nicaragua from the 1970s to the 1990s. The increase in women’s education was found to be the strongest explanatory factor behind this transition in fertility. Girls who had successfully completed at least 5 years of schooling had lower risk for early pregnancy. This protective effect of education was found for groups with high as well as low socioeconomic status.The background of adolescent pregnancy consists of a complex interaction of socioeconomic, familial and cultural factors. Lack of political will to challenge current values, religious influence in sexual and educational issues, romanticism and lack of empowerment, especially among adolescent women, are also influencing elements. Contraceptive use is still low among sexually active teenagers in Nicaragua, and pregnancy follows soon after first intercourse. There is a strong need for family life education at schools and health services geared to adolescents. Non-use of contraception is associated with poverty and lack of education. The association between education and fertility decline, and the protective effect of education in preventing early pregnancies, even among poor families, indicates that education is a powerful tool in breaking the vicious cycles of poverty and early pregnancy.
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| 11. |
- Zelaya Blandon, Elmer, et al.
(författare)
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Breaking the cycles of poverty : Strategies, achievements, and lessons learned in Los Cuatro Santos, Nicaragua, 1990-2014
- 2017
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: In a post-war frontier area in north-western Nicaragua that was severely hit by Hurricane Mitch in 1998, local stakeholders embarked on and facilitated multi-dimensional development initiatives to break the cycles of poverty. Objective: The aim of this paper is to describe the process of priority-setting, and the strategies, guiding principles, activities, achievements, and lessons learned in these local development efforts from 1990 to 2014 in the Cuatro Santos area, Nicaragua. Methods: Data were derived from project records and a Health and Demographic Surveillance System that was initiated in 2004. The area had 25,893 inhabitants living in 5,966 households in 2014. Results: A participatory process with local stakeholders and community representatives resulted in a long-term strategic plan. Guiding principles were local ownership, political reconciliation, consensus decision-making, social and gender equity, an environmental and public health perspective, and sustainability. Local data were used in workshops with communities to re-prioritise and formulate new goals. The interventions included water and sanitation, house construction, microcredits, environmental protection, school breakfasts, technical training, university scholarships, home gardening, breastfeeding promotion, and maternity waiting homes. During the last decade, the proportion of individuals living in poverty was reduced from 79 to 47%. Primary school enrolment increased from 70 to 98% after the start of the school breakfast program. Under-five mortality was around 50 per 1,000 live births in 1990 and again peaked after Hurricane Mitch and was approaching 20 per 1,000 in 2014. Several of the interventions have been scaled up as national programs. Conclusions: The lessons learned from the Cuatro Santos initiative underline the importance of a bottom- up approach and local ownership of the development process, the value of local data for monitoring and evaluation, and the need for multi-dimensional local interventions to break the cycles of poverty and gain better health and welfare.
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| 12. |
- Ziaei, Shirin, et al.
(författare)
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Women´s autonomy and social support and their associations with infant and young child feeding and nutritional status : community-based survey in rural Nicaragua
- 2015
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Ingår i: Public Health Nutrition. - 1368-9800 .- 1475-2727. ; 18:11, s. 1979-1990
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate the associations of women’s autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua.DesignCross-sectional study. Feeding practices and children’s nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women’s autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women’s social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles.SettingLos Cuatro Santos area, rural Nicaragua.Subjects A total of 1371 children 0–35 months of age.ResultsChildren of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller.ConclusionsWhile lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.
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