Papers by Stephen Hodgins
Global health, science and practice, Oct 3, 2018
The revised Helping Babies Breathe training package now emphasizes the need for regular practice ... more The revised Helping Babies Breathe training package now emphasizes the need for regular practice and quality improvement-an important improvement since more is needed than one-off training to have substantial impact on asphyxia-related newborn mortality. See related articles by Kamath-Rayne. HELPING BABIES BREATHE, FIRST EDITION The article by Kamath-Rayne et al., 1 in this issue of GHSP, reports on the review and revision of a widely deployed effort to reduce preventable asphyxia-related mortality and morbidity in newborns-Helping Babies Breathe (HBB). The American Academy of Pediatrics (AAP) developed this 1-to 2-day simulation-based training package on newborn resuscitation, finalizing it in 2010. Together with partners, including the World Health Organization, the United States Agency for International Development, Save the Children's Saving Newborn Lives program, the National Institute of Child Health and Human Development, and Laerdal Global Health, AAP subsequently introduced the program widely. The implementation effort, to date, has consisted primarily of large-scale campaigns to roll out the training (mainly on an in-service basis) and-in many casesproviding newborn resuscitation practice manikins in the health facilities where those trained are based. Impressively, close to half a million health workers across more than 80 countries have been reached with this training since HBB was first introduced. 2 Competing Interests: None declared.
Global health, science and practice, Oct 3, 2018
Carbetocin is more heat stable than oxytocin with at least equivalent efficacy for preventing pos... more Carbetocin is more heat stable than oxytocin with at least equivalent efficacy for preventing postpartum hemorrhage. It will certainly be helpful if the supplier can make it available in low-income country settings at a price comparable to oxytocin. But even so, programs will still need oxytocin and other uterotonic medications.
Global health, science and practice, Dec 20, 2018
Efforts continue-building on work of the UN Commission on Life-Saving Commodities for Women and C... more Efforts continue-building on work of the UN Commission on Life-Saving Commodities for Women and Children-to expand use of antenatal corticosteroids in low-resource settings. We argue that until more is known on the balance of benefit versus harm, such promotion should be suspended. See related article by Greensides. C orticosteroids are a synthetic version of the stress hormone cortisol. As such, they have manifold effects across systems and functions of the body including renal, vascular, endocrine, central nervous system, skin, gut, and-of most relevance for their use for imminent preterm labor-growth and development and immunological function (and, therefore, response to infection). We have evidence for the protective efficacy of antenatal corticosteroids, dating back to animal studies in the 1960s and clinical trials beginning in the 1970s. Roberts and Dalziel's Cochrane reviews 1 summarize the findings of these trials (mainly from high-income countries), notably that treatment with antenatal corticosteroids prior to imminent preterm birth, compared with placebo or no treatment, is associated with: 32% lower neonatal mortality (relative risk, 0.69; 95% confidence interval, 0.59 to 0.81; N=7188; 22 studies, from the 2017 review), and
Global health science and practice, Feb 15, 2024
Linking weather and health outcomes: Examining the potential influences of weather factors and particulate matter pollution on adverse pregnancy outcomes in the Kavre district, Nepal
Environmental research, May 1, 2024
Journal of Water Sanitation and Hygiene for Development, Feb 20, 2023
As climate change disrupts the global hydrological cycle, bringing extremes of flooding and droug... more As climate change disrupts the global hydrological cycle, bringing extremes of flooding and drought, many communities will experience changes in water and sanitation quality and access, requiring adaptive behavior changes. This study set out to map the adaptation patterns namely, the strategies employed to cope with water, sanitation, and hygiene (WASH)-related impacts of climate changewithin the Mabinju community, located along the banks of Lake Victoria in Western Kenya. Qualitative methods were employed, involving 17 semi-structured individual interviews and seven focus groups with village members. Insights derived from direct conversations with village members were deepened through qualitative interviews with an additional 13 WASH sector stakeholders working in the wider Lake Victoria Basin region. Through this study, various WASH-specific community adaptation measures were identified, with both positive and negative impacts on long-term local climate resilience. While many positive coping strategies were found to be spurred by the creative faculties of local residents, capacities for adaptation were found to be restrained by broader forces of poverty and resource access, resulting in the adoption of certain maladaptive coping mechanisms. These findings highlight the need for climate adaptation interventions in the WASH sector to simultaneously build on existing resilience-enhancing measures while addressing the root causes of maladaptation.
Contraceptive discontinuation in Togo and women's experience with method use and services
UMI Dissertation Services eBooks, 2000
Global health, science and practice, Sep 30, 2021
Alberta academic review, Oct 22, 2019
The world's population is rapidly ageing. Global estimates for the next three decades indicate a ... more The world's population is rapidly ageing. Global estimates for the next three decades indicate a twofold increase in the population of older adults aged ≥60 years. Nearly 80% of this growth will occur in low and middle-income countries in Asia and sub-Saharan Africa, where population health is already under threat from poverty, degraded environments, and deficient healthcare systems. Although the world's poorest region, sub-Saharan Africa, ironically, will witness the fastest growth in older populations, rising by 64% over the next 15 years. Indications are that the majority of this population will live in resource-poor settings, characterized by deficient housing and neighbourhood conditions. Yet, very little research has systematically examined the health and wellbeing of older adults in such settings. Drawing on the ecological theory of ageing, the present study explores the living conditions and quality of life of elderly slum dwellers in Ghana, a sub-Saharan African country with a growing population of older adults. Data collection was undertaken in two phases in two environmentally contrasting neighbourhoods in Accra, Ghana. In Phase 1, we carried out a cross-sectional survey of older adults in a slum community (n = 302) and a non-slum neighbourhood (n = 301), using the World Health Organization quality of life assessment tool (WHOQoL-BREF). The survey data were complemented in Phase 2 with qualitative interviews involving a sample of community dwelling older adults (N = 30), health service providers (N = 5), community leaders (N = 2), and policymakers (N = 5). Preliminary analysis of the survey data revealed statistically significant differences in the social and environment domains of quality of life, while the qualitative data identified multiple health barriers and facilitators in the two neighbourhoods. Insights from the research are expected to inform health and social interventions for older slum dwellers in Ghana.
Global health, science and practice, Mar 22, 2019
A hospital-based follow-up program in Uganda helped improve retention of patients in care across ... more A hospital-based follow-up program in Uganda helped improve retention of patients in care across a range of health problems. Although the specific approach may not be replicable in other settings, hospitals in Uganda and beyond should consider how they can improve retention of patients requiring long-term care, including for HIV, TB, malnutrition, and noncommunicable diseases. See related article by Alizadeh. A challenge all health care systems struggle with is ensuring needed continuity of care. The less robust the system, the more difficult that is. The article by Alizadeh et al., in this issue of GHSP, gives an account of efforts made by a rural district hospital in Kisoro, Uganda, to improve retention of patients across several different services in the hospital including those with HIV, receiving antiretrovirals (ARVs); tuberculosis (TB); severe malnutrition; and other chronic, noncommunicable diseases (NCDs). 1 The hospital developed a defaulter-tracking program, under which outreach staff would periodically visit clusters of villages once a threshold number of patients lost to follow-up was reached for that cluster, and encourage patients to return for follow-up treatment. The hospital made available a motorcycle for this purpose and offered field staff an incentive for patients successfully found and referred back for care.
Global health, science and practice, Apr 8, 2014
The proportion of pregnant women receiving 4 or more antenatal care (ANC) visits has no necessary... more The proportion of pregnant women receiving 4 or more antenatal care (ANC) visits has no necessary relationship with the actual content of those visits. We propose a simple alternative to measure program performance that aggregates key services that are common across countries and measured in Demographic and Health Surveys, such as blood pressure measurement, tetanus toxoid vaccination, first ANC visit before 4 months gestation, urine testing, counseling about pregnancy danger signs, and iron-folate supplementation.
Review of food-borne diseases in Nunavik
PubMed, 1998
Global health, science and practice, Jun 30, 2020
Small, well-implemented, well-evaluated community health worker programs can provide useful insig... more Small, well-implemented, well-evaluated community health worker programs can provide useful insights and inspiration. n Testing, learning, and adapting at progressively larger scale can ultimately lead to national-scale programs that achieve sustainable impact.
The New England Journal of Medicine, Mar 6, 2014
Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) h... more Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
Iron-deficiency anemia in Nunavik: pregnancy and infancy
PubMed, 1998
Purpose: This paper documents the problem of iron-deficiency anemia in the Inuit region of Nunavi... more Purpose: This paper documents the problem of iron-deficiency anemia in the Inuit region of Nunavik, in Northern Quebec, particularly among pregnant women and infants. It also addresses the issue of Helicobacter pylori gastritis as a possible cause of anemia in this population. Method: Data on anemia in pregnancy are from routinely collected prenatal records. Data on anemia in infants are drawn from blood samples collected for a study on the impact of environmental contaminants. Helicobacter serologies were done on cord-blood specimens from 100 consecutive births screened for contaminant exposure. For comparison, serologies were done on a series of cord-blood specimens from 99 births in Southern Quebec. Results: By term, 40% of pregnant women in Nunavik are anemic (Hgb < 115 g/L). Of infants aged 9-14 months, 58% are anemic (Hgb < 110 g/L), and among the remaining 42%, over half have depleted iron stores. Twenty-seven percent of the Nunavik sample had positive or equivocal Helicobacter serologies. In the comparison group, 10% were positive or equivocal.
International Journal of Circumpolar Health, Sep 1, 2004
Objectives. Birth defects occur in all ethnic groups, remaining an important worldwide cause of p... more Objectives. Birth defects occur in all ethnic groups, remaining an important worldwide cause of perinatal and infant morbidity. This contributes greatly to an excess of health care dollars allocated to the care and repair of those affected. This is especially true when those affected live in remote geographical locations. Study design. A chart review of 2567 live births of children of Inuit parents residing in Arctic Quebec (Nunavik) and on Baffin Island (Nunavut) between 1989 and 1994 (five years) was carried out compared to rates of anomalies of the Alberta Congenital Anomalies Surveillance System (ACASS). Results. Birth defects were higher in the Inuit sample in nearly every major ICD-9 category with the exception of neural tube defects, eye anomalies and chromosome abnormalities. (Total: 99.7/1000 Vs 51.5/1000; OR 1.93 95% CI 1.7-2.3). Congenital heart defects were significantly increased 22.9/1000 Vs 5.6/1000, with an OR of 4.18 (95% CI 3.2-5.4) in the ICD-9 category 745. In particular, ventricular septal defects (VSDs) and atrial septal defects (ASDs) (OR 4.9 CI 3.5-6.9 and 4.6 CI 2.9-7.2) were frequent. Conclusions. A high rate of heart defects was an important contributor to the nearly two times rate of total birth defects in the Inuit compared to the ACASS. Further study should be carried out to determine the contributing factors. Genetic predisposition to specific heart defects, and a diet low in folate and vitamin A are considerations. The use of alcohol may exacerbate vitamin status in pregnancy. Optimizing vitamin status in the periconceptional period may reduce the rate of birth defects.
Journal of Water Sanitation and Hygiene for Development, Feb 20, 2023
As climate change disrupts the global hydrological cycle, bringing extremes of flooding and droug... more As climate change disrupts the global hydrological cycle, bringing extremes of flooding and drought, many communities will experience changes in water and sanitation quality and access, requiring adaptive behavior changes. This study set out to map the adaptation patterns namely, the strategies employed to cope with water, sanitation, and hygiene (WASH)-related impacts of climate changewithin the Mabinju community, located along the banks of Lake Victoria in Western Kenya. Qualitative methods were employed, involving 17 semi-structured individual interviews and seven focus groups with village members. Insights derived from direct conversations with village members were deepened through qualitative interviews with an additional 13 WASH sector stakeholders working in the wider Lake Victoria Basin region. Through this study, various WASH-specific community adaptation measures were identified, with both positive and negative impacts on long-term local climate resilience. While many positive coping strategies were found to be spurred by the creative faculties of local residents, capacities for adaptation were found to be restrained by broader forces of poverty and resource access, resulting in the adoption of certain maladaptive coping mechanisms. These findings highlight the need for climate adaptation interventions in the WASH sector to simultaneously build on existing resilience-enhancing measures while addressing the root causes of maladaptation.
Contraceptive discontinuation in Togo and women's experience with method use and services
UMI Dissertation Services eBooks, 2000
Quality of life of older adults in two contrasting neighbourhoods in Accra, Ghana
Social Science & Medicine, Feb 1, 2021
As is the case elsewhere in sub-Saharan Africa, Ghana is experiencing a rapid increase in the pop... more As is the case elsewhere in sub-Saharan Africa, Ghana is experiencing a rapid increase in the population of older adults. Despite their rising numbers, the living conditions and wellbeing of older Ghanaians remain woefully understudied. This paper presents the results of a study exploring the quality of life (QoL) of older adults in two contrasting neighbourhoods in Accra, Ghana. The objectives of the study were to: (1) explore and compare the QoL of older slum and non-slum dwellers in Ghana; and (2) determine the extent of QoL disparities between slum and non-slum older adults. To accomplish these objectives, we undertook a cross-sectional survey of older adults (N = 603) residing in a slum and non-slum neighbourhood. QoL was self-assessed in four domains - physical, psychological, social, and environment - using the World Health Organization (WHO) QoL assessment tool (WHOQoL-BREF). Multivariable linear regression analyses of the data revealed no statistically significant difference between the slum and non-slum respondents in physical (coeff: 0.5; 95% CI: -1.7, 2.8; p = 0.642) and psychological (coeff: -0.2; 95% CI: -3.0, 2.6; p = 0.893) QoL. However, the slum respondents reported significantly higher social QoL than the non-slum respondents (coeff: -3.2; 95% CI: -5.6, -0.8; p = 0.010), while the reverse was true in environmental QoL (coeff: 4.2; 95% CI: 2.3, 6.2; p < 0.001). The existence of strong social support systems in the slum and better housing and neighbourhood environmental conditions in the non-slum may have accounted for the observed variation in social and environmental QoL. Thus, contrary to popular discourses that vilify slums as health-damaging milieus, these findings offer a more nuanced picture, and suggest that some features of slums may constitute important health resources for older adults.
Quality of life of older adults in two contrasting neighbourhoods in Accra, Ghana
Social Science & Medicine, Feb 1, 2021
As is the case elsewhere in sub-Saharan Africa, Ghana is experiencing a rapid increase in the pop... more As is the case elsewhere in sub-Saharan Africa, Ghana is experiencing a rapid increase in the population of older adults. Despite their rising numbers, the living conditions and wellbeing of older Ghanaians remain woefully understudied. This paper presents the results of a study exploring the quality of life (QoL) of older adults in two contrasting neighbourhoods in Accra, Ghana. The objectives of the study were to: (1) explore and compare the QoL of older slum and non-slum dwellers in Ghana; and (2) determine the extent of QoL disparities between slum and non-slum older adults. To accomplish these objectives, we undertook a cross-sectional survey of older adults (N = 603) residing in a slum and non-slum neighbourhood. QoL was self-assessed in four domains - physical, psychological, social, and environment - using the World Health Organization (WHO) QoL assessment tool (WHOQoL-BREF). Multivariable linear regression analyses of the data revealed no statistically significant difference between the slum and non-slum respondents in physical (coeff: 0.5; 95% CI: -1.7, 2.8; p = 0.642) and psychological (coeff: -0.2; 95% CI: -3.0, 2.6; p = 0.893) QoL. However, the slum respondents reported significantly higher social QoL than the non-slum respondents (coeff: -3.2; 95% CI: -5.6, -0.8; p = 0.010), while the reverse was true in environmental QoL (coeff: 4.2; 95% CI: 2.3, 6.2; p < 0.001). The existence of strong social support systems in the slum and better housing and neighbourhood environmental conditions in the non-slum may have accounted for the observed variation in social and environmental QoL. Thus, contrary to popular discourses that vilify slums as health-damaging milieus, these findings offer a more nuanced picture, and suggest that some features of slums may constitute important health resources for older adults.
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Papers by Stephen Hodgins