Evidence suggests that increasing male involvement in maternal and newborn health (MNH) may improve MNH outcomes. However, male involvement is difficult to measure, and further research is necessary to understand the barriers and enablers for men to engage in MNH, and to define target groups for interventions. Using data from a peri-urban township in Myanmar, this study aimed to construct appropriate indicators of male involvement in MNH, and assess sociodemographic, knowledge and attitude correlates of involvement. A cross-sectional study of married men with one or more children aged up to one year was conducted in 2012. Structured questionnaires measured participants’ involvement in MNH, and their sociodemographic characteristics, knowledge and attitudes. An ordinal measure of male involvement was constructed describing the subject’s participation across five areas of MNH, giving a score of 1–4. Proportional-odds regression models were developed to determine correlates of male involvement. A total of 210 men participated in the survey, of which 203 provided complete data. Most men reported involvement level scores of either 2 or 3 (64 %), with 13 % reporting the highest level (score of 4). Involvement in MNH was positively associated with wives’ level of education (AOR = 3.4; 95 % CI: 1.9-6.2; p < 0.001) and men’s level of knowledge of MNH (AOR = 1.2; 95 % CI: 1.1-1.3; p < 0.001), and negatively correlated with number of children (AOR = 0.78; 95 % CI: 0.63-0.95; p = 0.016). These findings can inform the design of programs aiming to increase male involvement, for example by targeting less educated couples and addressing their knowledge of MNH. The composite index proved a useful summary measure of involvement; however, it may have masked differential determinants of the summed indicators. There is a need for greater understanding of the influence of gender attitudes on male involvement in Myanmar and more robust indicators that capture these gender dynamics for use both in Myanmar and globally.

The aim of this study was to test the efficacy and appropriateness of the World Health Organization's Care for Development (CFD) counseling materials, which form part of the Integrated Management of Childhood Illness (IMCI) strategy. The CFD materials are based on the Mother's Card, which contained age-specific messages on how caregivers can better play and communicate with a child. We enrolled 100 families with a child of younger than 2 years of age from seven randomly selected villages in an impoverished rural county in Anhui Province, China. Two counseling sessions, using the CFD Mother's Card, were provided to 50 families randomly selected from among the study participants. All children were assessed with Gesell Developmental Schedules before counseling and after 6 months. A questionnaire on family situation and knowledge, attitudes, and practices regarding child development was also administered at the start and conclusion of the study. At baseline assessment, both control and intervention groups were equal, with average developmental scores less than the national norms. Children in families who received counseling had significantly higher development quotient scores in cognitive, social, and linguistic domains. Questionnaire data on child rearing suggested that responsive and rich interactions and consistent caregivers correlated with higher scores. The CFD Mother's Card was found to be feasible and helpful in those families who received counseling. There is urgent need for further work on promotion of child development in rural China. The World Health Organization's CFD approach and Mother's Card is feasible and effective and should be expanded in use, especially within the national IMCI program.

A WHO global strategy launched in November 2020 sets out an ambitious pathway towards the worldwide elimination of cervical cancer as a public health problem within the next 100 years. Achieving this goal will require investment in innovative approaches. This review aims to describe integrated approaches that combine human papillomavirus (HPV) vaccination and cervical cancer screening in low- and middle-income countries (LMIC), and their efficacy in increasing uptake of services. A systematic review was conducted analyzing relevant papers from Embase, Medline, CINAHL and CAB Global Health databases, as well as grey literature. Narrative synthesis was performed on the included studies. Meta-analysis was not appropriate due to the heterogeneity and nature of included studies. From 5,278 titles screened, 11 uncontrolled intervention studies from four countries (from Africa and east Asia) were included, all from the past 12 years. Four distinct typologies of integration emerged that either increased awareness of HPV and/or cervical cancer screening, and/or coupled the delivery of HPV vaccination and cervical cancer screening programs. The synthesis of findings suggests that existing HPV vaccination programs can be a useful pathway for educating mothers and other female caregivers about cervical cancer screening; through in person conversations with care providers (preferred) or take-home communications products. Integrated service delivery through outreach and mobile clinics may overcome geographic and economic barriers to access for both HPV vaccination and cervical cancer screening, however these require significant program and system resources. One study promoted HPV vaccination as part of integrated service delivery, but there were no other examples found that examined use of cervical cancer screening platforms to promote or educate on HPV vaccination. This review has demonstrated gaps in published literature on attempts to integrate HPV vaccination and cervical cancer screening. The most promising practices to date seem to relate to integrated health communications for cervical cancer prevention. Future research should further explore the opportunities for integrated health communications to support the efforts towards the new global cervical cancer elimination agenda, and costs and feasibility of integrated service delivery for underserved populations.

Objectives To explore barriers to free cervical cancer screening among rural women in China from the perspective of women, healthcare providers and women’s husbands to inform intervention planning. Design A qualitative study framed around potential policy and practice options, drawing on the concepts of descriptive phenomenology and implementation research. Setting This study was carried out at township level within two counties in Jining Prefecture of eastern China. Participants and data collection Semi-structured in-depth interviews with 21 women and five healthcare providers, focus group discussions with nine healthcare providers and key informant interviews with four husbands of women eligible for screening. Results Thematic analysis generated five major themes: (1) gaps in knowledge of cervical cancer and health awareness, (2) fear of cancer and screening outcomes, (3) cultural barriers including reticence for intimate examinations, (4) influence of close contacts on screening decisions and (5) inconvenience. These demonstrate key knowledge gaps challenging current community health education. Important barriers, including fear of treatment cost and the time needed for screening, were also raised. Conclusion Our study details important barriers to cervical cancer screening relating to knowledge gaps, attitudes of fear or embarrassment and the role of contacts and service models. These provide data for policy and planning to improve the screening that will decrease the incidence and mortality rates of cervical cancer in China.

The controlled temperature chain (CTC) strategy allows vaccines to be kept outside the cold chain for a short period of time. In remote rural areas, the CTC strategy for the hepatitis B virus (HBV) birth dose vaccination could improve its geographical coverage and timeliness of delivery, but with additional outreach costs. We assessed the cost-effectiveness of the CTC strategy for the HBV birth dose across six world regions and 72 countries according to their HBV prevalence, delivery costs, and birth dose coverage and timing. By use of a mathematical model of perinatal HBV transmission and disease progression, we calculated per 1000 births the total HBV-related disability-adjusted life-years (DALYs) and costs, including vaccine delivery costs and costs associated with HBV-related disease, with and without the CTC strategy. A CTC strategy produced health benefits in all regions and was cost-saving in the regions of east Asia and Pacific, Latin America and Caribbean, sub-Saharan Africa, and north Africa and Middle East. The CTC strategy cost US$0·15 (IQR -7·11 to 4·75) per DALY averted in the central and eastern Europe and central Asia region and $79·72 (66·47 to 94·47) in the south Asia region. Within individual countries, more savings were achieved and more DALYs averted in areas with above average HBV prevalence, below average birth dose coverage, or later than average birth dose delivery. A CTC outreach strategy that improves the timing and coverage of the HBV birth dose vaccination is likely to be cost-saving and reduce the burden of HBV infection associated with perinatal transmission. Burnet Institute.