Male partner 9 letters
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- A favorite male companion 9 letters
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- OUTCOME AND COST OF 3 METHODS FOR INCREASING MALE PARTNER TESTING IN SOUTH AFRICA
- An Open Letter to Betrayed Male Partners
Male partner - Crossword Clue
The low level of male partner involvement in Prevention of Mother to Child Transmission of HIV services such as safe infant feeding practices poses a serious challenge to the implementation of guidelines on safe infant feeding and may undermine efforts towards elimination of mother to child transmission of HIV in sub Saharan Africa SSA. We conducted a systematic review and meta-analysis to identify the approaches that have been utilized to improve male partner involvement in PMTCT services as well as their impact on the uptake of safe infant feeding practices by HIV positive mothers in SSA.
Only studies performed in SSA that reported an approach that specifically involved male partners and its impact on the uptake of safe infant feeding practices irrespective of the language and date of publication were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version Forest plots were generated using the random effect model.
From an initial non-duplicate articles, 06 articles were included in the systematic review and meta-analysis. The overall pooled unadjusted OR was 3. Interventions aimed at promoting male partner involvement such as enhanced psychosocial interventions, verbal encouragement and complex community interventions increase the uptake of safe infant feeding options.
The heterogeneity was moderate among studies. More studies including randomised trials that will recruit larger, representative samples of patients are needed in the future. A systematic review and meta-analysis. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files. Competing interests: The authors have declared that no competing interests exist. Contemporary evidence to explain this persistent disproportionate burden point towards the complex socio-cultural context in the region that impedes the effective participation of communities in HIV prevention activities such as safe infant feeding practices by HIV positive mothers [ 4 ].
The World Health Organization WHO guidelines on safe infant feeding practices for HIV positive mothers calls for exclusive breastfeeding by HIV mothers on antiretroviral therapy or opting out of breastfeeding infant formula with discouragement of mixed infant feeding [ 5 ].
Despite this recommendation, mixed infant feeding is still largely observed in many settings across sub Saharan Africa mainly due to the sociocultural belief that breast milk might not be sufficient for the infant [ 6 ].
Intricately linked to this sociocultural context is the role of male partner involvement in providing the necessary psychosocial support needed by HIV positive women to shun mixed infant feeding [ 7 ].
Male partner involvement in the prevention of mother to child transmission of HIV encompasses communication between spouses including HIV status disclosure , antenatal care attendance and childbirth, antenatal testing and couples combination antiretroviral therapy ART and antenatal support during pregnancy and infant feeding decision support [ 8 ].
Furthermore, a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps has shown that the involvement of male partners PMTCT plays a crucial role in retention of pregnant women [ 10 ]. Studies in the area of male partner involvement have suggested a positive impact on the uptake of PMTCT services.
Baiden et al in a cross-sectional study showed that women who demonstrated a strong sense of willingness to be accompanied by their male partners were five times more likely to accept HIV testing during antenatal care OR 5.
Furthermore, using a randomised controlled trial RCT , Kiarie et al showed that compliance to antiretroviral regimens in pregnancy was strongly associated with partner notification OR 7.
Studies have reported approaches that can be used in involving male partners in PMTCT such as invitation letters and complex interventions that use more than one strategy to engage male partners in the community [ 16 ]. It was therefore necessary to conduct this systematic review and meta-analysis to determine these approaches and their impact on the uptake of infant feeding practices in view of informing policy makers, governments, implementing partners such as NGOs and researchers on how the uptake of PMTCT services can be improved through increased engagement of male partners.
The registration number is CRD In the protocol we considered outcomes such as infant antiretroviral prophylaxis uptake, maternal ART uptake, safe infant feeding practices, condom use as well as family planning. However, we decided in this review to focus on the safe infant feeding practices outcome due to its significant role in reducing the vertical transmission of HIV.
This review considered studies that were conducted in SSA. Studies conducted outside of the SSA region were excluded. No restriction was placed on the setting of the study and the language of study. Randomized controlled trials, prospective and retrospective cohort studies, and serial cross sectional studies were eligible for inclusion. Studies were included if they provided data on the impact of male partner involvement on the uptake of safe infant feeding practices.
One time cross-sectional studies and case-control studies were excluded because they did not present any evidence of the impact of male partner involvement. The participants were HIV positive mothers. A literature search was conducted from December 1st through May 30th inclusive. Current Controlled Trials and ClinicalTrials. A final search was conducted on May 30, A detailed search strategy is shown in Table 1.
The outputs of the search were exported to Mendeley desktop 1. The full texts were obtained from the screened abstracts after inclusion and exclusion criteria were applied. Authors of articles were contacted for further information on any publication. A data extraction spreadsheet was developed in excel version The outcome of interest was uptake of safe infant feeding practices.
Odds ratios were extracted from individual studies. Relative risks and proportions were converted to ORs. Any disagreement was settled by a third reviewer LNA. Also, adjusted odds ratios were extracted from the studies.
These has been summarized in an excel sheet and submitted as part of the data extraction sheet S2 Table. The characteristics of included studies were summarized in Table 2. The studies that remained relevant following application of inclusion and exclusion criteria were used in the synthesis.
Studies with data on impact of male involvement on the uptake of safe infant feeding practices were considered for a meta-analysis that was performed using statistical software Stata version In this review the studies included varied significantly in terms of approaches and outcomes which suggests that the true effect sizes measured could also differ. These disparities could very likely introduce high heterogeneity. Therefore, the random effect model was used to pool the evidence from the studies.
Heterogeneity was assessed using the I squared statistic generated. The Newcastle Ottawa scale was used in assessing the quality of non-randomized studies [ 21 ]. This scale captured 8 core elements divided into 3 broad elements related to the study quality. The first element was to determine the representativeness of the exposed cohort. The second element was to determine if the study controlled for other variables.
The Third element was to determine if there was bias in the measurement of the outcome. Six studies were finally included in the systematic review and meta-analysis. All six studies were cohort studies. Table 2 shows the characteristics of included studies. The studies included a total of HIV positive mothers ranging from to In four of the studies, HIV positive mothers were encouraged verbally through counselling to bring their partners for counselling to the clinic [ 12 , 22 — 24 ].
One study by Farquhar et al used enhanced psychosocial intervention to involve male partners [ 25 ]. The couples decided on the gender of the HIV peer counsellor. These specifically trained peer counselors were well equipped with communication skills that could improve on the level of male partner involvement.
The study by Semrau et al involved the use of complex community interventions to improve on male partner involvement [ 26 ]. These were complex community interventions because several approaches to involve male partners were coupled with other changes in health care delivery to improve on maternal and child care within the community.
Community mobilization talks and dramas were carried out. During these community meetings, community members were educated on the relevance of early antenatal clinic attendance of couples and the role of male partners in supporting the uptake of PMTCT services by women. Semrau et al engaged community health workers to carry out mobilization talks and dramas in football events, market places, clubs, churches and work places. The results of the quality assessment are shown in Fig 2.
None of the final eligible studies selected a representative sample of patients which most likely resulted in selection bias. In three studies the cohort possessed special characteristics that did not represent the general characteristics in the setting [ 23 — 25 ]. In the Farquhar et al study, the couples were older, more educated and more likely to engage in HIV prevention activities. Brou et al recruited a consecutive sample of older HIV positive women who were more likely to be in polygamous marriages.
Msuya et al included women who were younger, less educated and less likely to engage in prevention activities. Semrau et al consecutively selected participants only from socioeconomic disadvantaged communities while Aluiso et al and Kalembo et al recruited consecutively from a single district hospital. Two of the studies did not adjust for confounding [ 23 , 26 ].
Furthermore in terms of follow-up, participants in all the final selected studies had long enough follow-up time to observe the outcome but only the study by Aluiso et al provided evidence to justify that the characteristics of participants lost to follow-up LTFU were similar to those retained [ 12 ]. Fig 3 shows the overall forest plot for the studies that reported the impact of male involvement on the uptake of safe infant feeding practices.
The funnel plot in Fig 5 shows very a uniform scaterring of points along the central axis. A meta-analysis of Odds Ratios from six studies showed a statistically significant increase in the uptake of safe infant feeding practices with male partner involvement. This increase was associated with enhanced psychosocial intervention, verbal encouragement and complex community interventions. These findings are in contrast to what Brusamento and colleagues reported [ 27 ].
Even though Brusamento et al thoroughly evaluated multiple databases with a comprehensive and systematic search strategy, independently assessing the quality of individual studies, the search strategy was biased towards identifying only randomized controlled trials which might explain why the authors failed to also include relevant cohort studies that could have improved on the evidence synthesis with possible meta-analysis.
Another possible reason for the disagreement with the Brusamento et al study is that the authors drew their conclusion from a single study that used only invitation letters as an approach to involve male partners. Our study has shown that other categories of interventions exist such as enhanced psychosocial intervention, verbal encouragement and complex community interventions that have a positive impact on the uptake of safe infant feeding practices.
In addition, by pooling together the evidence from different studies in a meta-analysis, our study provides more convincing evidence than the Brusamento et al study that drew conclusions from a single unblinded randomised trial. Our study is also different from two reviews conducted in the domain of male involvement [ 28 , 29 ]. The systematic review by Yargawa and colleagues focused only on maternal outcomes such as postpartum depression, utilization of hospital services and postnatal care [ 28 ].
The postpartum care did not involve infant feeding practices. Compared with the Auvinen et al study [ 29 ], our study did not identify invitation letters as a strategy to specifically improve the uptake of safe infant feeding practices. However, it should be noted that the study by Auvinen et al was a narrative review with no systematic search strategy, no multiple database search, and no independent assessment of the quality of included studies.
In addition, since the Auvinen study was a narrative review with no focus on the impact on outcomes, the authors could not provide data on the impact of male involvement on the uptake of safe infant feeding practices. Our study has shown that enhanced psychosocial interventions improve the uptake of safe infant feeding practices.
Gee, A Girl Getting Married Around A Bit Of The Army!
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The low level of male partner involvement in Prevention of Mother to Child Transmission of HIV services such as safe infant feeding practices poses a serious challenge to the implementation of guidelines on safe infant feeding and may undermine efforts towards elimination of mother to child transmission of HIV in sub Saharan Africa SSA. We conducted a systematic review and meta-analysis to identify the approaches that have been utilized to improve male partner involvement in PMTCT services as well as their impact on the uptake of safe infant feeding practices by HIV positive mothers in SSA. Only studies performed in SSA that reported an approach that specifically involved male partners and its impact on the uptake of safe infant feeding practices irrespective of the language and date of publication were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version Forest plots were generated using the random effect model.
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A favorite male companion 9 letters
A Stroud District Council spokesperson said there was no evidence of theft or attack, and he had most likely flown away. Last Updated:. Female swan at Stratford Park lake abandoned by male partner after 15 years 2. Sorry, an error occurred.
A penfriend is a person, often in a foreign country, with whom one exchanges friendly correspondence but whom one never or rarely meets. Not enough words? Include all words forms plurals and conjugated verbs.
Female swan at Stratford Park lake abandoned by male partner after 15 years
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OUTCOME AND COST OF 3 METHODS FOR INCREASING MALE PARTNER TESTING IN SOUTH AFRICA
Official invitation letters to promote male partner attendance and couple voluntary HIV counselling and testing in antenatal care: an implementation study in Mbeya Region, Tanzania. However, in. Previous research has suggested written invitation letters as a way to promote male partner involvement. Methods: In this implementation study conducted at three study sites in southwest Tanzania, acceptability of written invitation letters for male partners was assessed. Pregnant women approaching ANC without a male partner were given an official letter, inviting the partner to attend a joint ANC and couple voluntary counselling and testing CVCT session. Partner attendance was recorded at subsequent antenatal visits, and the invitation was repeated if the partner did not attend.
Despite high uptake of HIV testing among pregnant women, male partner testing within antenatal clinics ANC remains low. This study was conducted at a large health center in the Bojanala District of South Africa from January — October All pregnant women, whose partner was HIV-negative or of unknown status, were offered three options for partner testing: 1 a partner invitation letter for facility testing; 2 home testing; or 3 up to 2 Ora-Quick self-test kits to take to their male partners.
An Open Letter to Betrayed Male Partners
Скажи, что ты ушел с поста декана. Дэвид кивнул. - В следующем семестре я возвращаюсь в аудиторию. Сьюзан с облегчением вздохнула: - Туда, где твое подлинное призвание.
Он лишь хотел, чтобы восторжествовала правда. Это касалось ТРАНСТЕКСТА. Это касалось и права людей хранить личные секреты, а ведь АНБ следит за всеми и каждым. Уничтожение банка данных АНБ - акт агрессии, на которую, была уверена Сьюзан, Танкадо никогда бы не пошел.
Беккер почувствовал, что у него подкашиваются ноги. Этого не может .
Росио угрожающе приблизилась. - Я знаю всех полицейских в этом городе. Они мои лучшие клиенты. Беккер чувствовал, как ее глаза буквально впиваются в .
Вы думаете, он, умирая, до последний секунды переживал за несчастное АНБ. - Распадается туннельный блок! - послышался возглас одного из техников. - Полная незащищенность наступит максимум через пятнадцать минут.
- Вот что я вам скажу, - решительно заявил директор. - Через пятнадцать минут все страны третьего мира на нашей планете будут знать, как построить межконтинентальную баллистическую ракету.
При чем здесь таблица умножения? - подумала Сьюзан. - Что он хочет этим сказать. - Четыре на шестнадцать, - повторил профессор.