Heartfile

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IntroductionRapid population growth, stagnant contraceptive prevalence, and high unmet need for family planning present significant challenges for meeting Pakistan’s national and international development goals. Although health behaviors are shaped by multiple social and environmental factors, research on contraceptive uptake in Pakistan has focused on individual and household determinants, and little attention has been given to community characteristics that may affect access to services and reproductive behavior.MethodsIndividual and community determinants of contraceptive use were identified using multivariable multilevel logistic regression to analyze data from a 2014 cross-sectional survey of 6,200 mothers in 503 communities in Sindh, Pakistan.ResultsOnly 27% of women who had given birth in the two years before the study reported using contraceptives. After adjusting for individual and community characteristics, there was no difference in the odds of contraceptive use between urban and rural women. Women who had delivered at a health facility had 1.4 times higher odds of contraceptive use than women who delivered at home. Those who received information about birth spacing from a doctor or relatives/friends had 1.81 and 1.38 times higher odds of contraceptive use, respectively, than those who did not. Living in a community where a higher proportion of women received quality antenatal care and where discussion of birth spacing was more common was significantly associated with contraceptive use. Community-wide poverty lowered contraceptive use.ConclusionsQuality of care at the community level has strong effects on contraceptive use, independent of the characteristics of individual households or women. These findings suggest that powerful gains in contraceptive use may be realized by improving the quality of antenatal care in Pakistan. Community health workers should focus on generating discussion of birth spacing in the community. Outreach efforts should target communities where the demand for contraception appears to be depressed due to high levels of poverty.

Commonalities abound varied health challenges confronting Pakistan and India. Some of these warrant joint collaborative solutions. This study presents existing health collaborations by mapping out active connections between the countries, through a literature review and clinical and public health professionals’ interviews. It reveals that a diversity of practices exist beyond the usual notions of ‘collaboration’ usually depicted in the literature. Outcomes from such initiatives included enhanced learning and exchanges of information and research across various communities and contexts. In various adoptions of the term, contextualisation within and between countries and amongst particular communities is cited as important. Travel and mobility restriction emerged as one key issue that hampers and discourages collaborations. Key lessons conveyed by the participants included an enabling environment, missing on both sides of the border. Opportunities and recommendations are presented to address the obstacles that discourage cross-border dialogue and to enhance collaborations between the two countries.

Summary The Russian Federation has one of the lowest life expectancies in Europe, as well as having the highest rates of death and disability due to cardiovascular disease (CVD). In order to sensitize the professional and public-health community and the public to the growing challenge of cardiovascular disease, the World Heart Federation, in partnership with the Russian Society of Cardiology and the City Public Health Care Administration and with the support of Unilever Bestfoods, carried out a pilot social marketing project in the central Russian city of Ekaterinburg. The primary objective was to assess the viability of a cardiovascular disease-focused social marketing campaign in terms of its diffusion in the population and its acceptability. The social marketing campaign itself involved community interventions, a mass media campaign and training of health care professionals. Progress towards achieving this and the secondary objectives were measured by evaluating changes in a set of predetermined output and outcome indicators. A pre-test/post-test control-group quasi-experimental design was used for examining project outcomes. The results showed a significant level of acceptability and diffusion, which need to be further developed for large-scale use. Because of its short duration, the project cannot be held to expectations of influencing behavioural risk, but in terms of meeting its primary objective, it has been successful.