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Expanding Use of Magnesium Sulfate for Treatment of Pre-eclampsia and Eclampsia

December 1, 2014

Pre-eclampsia/eclampsia is a serious condition that can develop during pregnancy, even in women with no risk factors. Although there is little understanding of what causes pre-eclampsia/eclampsia, there is an effective treatment for this condition which, if left untreated, can progress to coma and death. In 1994, the World Health Organization (WHO) recommended magnesium sulfate as the standard treatment for pre-eclampsia and eclampsia and within two years it was placed on WHO's Essential Medicines List. Despite its known efficacy, this inexpensive drug is often underutilized, in part because the diffusion of innovation takes time but also because of the service delivery challenges inherent to the use of magnesium sulfate—it requires a strong and effective referral system, often a challenge in under-resourced health systems. The underutilization of magnesium sulfate has been a recognized problem in Nigeria for some time; prior to 2007 there was almost no magnesium sulfate in the country.The significant contribution of pre-eclampsia/eclampsia to maternal mortality in Nigeria—along with the promise of magnesium sulfate as a solution—caught the attention of the John D. and Catherine T. MacArthur Foundation in 2005 when a program officer overheard a conversation between two Nigerian doctors who were lamenting the failure of a piece of equipment in their hospital laboratory that was used for manufacturing magnesium sulfate. Without it, one was saying to the other, they would have no supply of the drug to treat pre-eclampsia/eclampsia and no way to save women's lives. The Foundation decided to fund a series of grants to expand the use of magnesium sulfate for pre-eclampsia/eclampsia in Nigeria and, in 2014, commissioned an evaluation of that work. This case study describes the findings of the evaluation, including the challenges encountered while implementing the projects, the successes achieved, and existing opportunities for future scaling up of the services across the country.

Scaling up Access to Misoprostol at the Community Level to Improve Maternal Health Outcomes in Ethiopia, Ghana, and Nigeria

December 1, 2014

Over the past decade (2004–2014), the Population and Reproductive Health area of the MacArthur Foundation has focused on supporting projects aimed at reducing maternal mortality. In particular, it has supported efforts to use misoprostol to prevent postpartum hemorrhage, the anti-shock garment to aid in the treatment of hemorrhage, and magnesium sulfate to decrease deaths from eclampsia. In recent years, the Foundation has invested in a range of research and evaluation efforts to better understand these interventions, their effectiveness, and the extent to which successful pilot projects have been scaled up.In 2014, the Foundation commissioned the Public Health Institute to evaluate the grants it had made to increase community-based access to misoprostol for postpartum hemorrhage prevention in Ethiopia, Ghana, and Nigeria. Specifically, the Foundation was interested in documenting the models and approaches used and the progress toward scaling up the respective models in the three countries. Between June and November 2014, the evaluation team reviewed grantee reports, proposals, and the literature; interviewed key informants and global, national, and local stakeholders; conducted focus group discussions with local stakeholders; and made observations during site-visits in each country. From this the team produced case study reports relating to misoprostol use in each country. This report is a synthesis of those three case studies, highlighting the common findings across the projects, identifying differences, and interpreting the lessons learned for broader use and scale up of misoprostol at the community level in Africa and globally.

AGALI, 2012 Annual Report

January 1, 2013

The Adolescent Girls' Advocacy & Leadership Initiative improves adolescent girls' health, education, and livelihoods in Africa and Latin America. AGALI empowers leaders and organizations to advocate for girl-friendly laws, policies, and funding in Guatemala, Honduras, Liberia, Malawi, and Ethiopia. Through capacity building workshops, seed grant funding, and technical assistance, AGALI has created a global movement of leaders and organizations advocating for girls. AGALI's impacts include the passage and implementation of national laws, policies, and programs that protect girls from violence, increase their access to education, health services, and economic opportunities, and empower young women to develop their own solutions to the obstacles they face. AGALI Fellows and their institutions have provided direct training and services to over 40,000 adolescent girls and their allies, in addition to engaging 600 grassroots organizations in girl-centered advocacy efforts.

AGALI, 2011 Annual Report

January 1, 2012

The Adolescent Girls' Advocacy & Leadership Initiative (AGALI) has worked for the past three years to strengthen the capacity of civil society leaders and organizations in Latin America and Africa to advocate with and for marginalized adolescent girls. During 2011, the Public Health Institute (PHI) implemented the AGALI program in Guatemala, Liberia, Malawi, Ethiopia, and Honduras with a $550,000 grant from the UN Foundation (please see Attachment A: Financial Report for more details). Since the program's inception, AGALI has strengthened the ability and commitment of leaders and institutions to advocate for laws, policies, and funding that respond to adolescent girls' needs, while enhancing young women's ability to develop their own solutions to the social, economic, and health challenges they face. The AGALI program uses a multi-faceted approach to improve adolescent girls' welfare that includes intensive workshops, seed grants, technical assistance, institutional strengthening, a structured outreach and dissemination process, and building the knowledge base for the field of adolescent girls. AGALI's comprehensive model strengthens the capacity of civil society leaders and organizations to advance the efforts of the United Nations' country programs and the UN Adolescent Girls' Task Force (AGTF) to promote adolescent girls' human rights, health, education, and socio-economic wellbeing in UN priority focus countries.

Almost One-Quarter of California Nonelderly Women Uninsured in 2009

December 16, 2011

Based on 2009 California Health Interview Survey data, outlines trends in women's health coverage by type and the percentage of uninsured women by age, race/ethnicity, income, family and work status, and region. Examines the role of the safety net.

No Time for Complacency: Teen Births in California

June 9, 2008

Analyzes California's rising teen birth rate by state senate district; explores its social and economic impacts on mothers, families, and society; and suggests actions for the leadership, prevention programs, educational policy, schools, and communities.

Sex Education: The Parent's Perspective

May 1, 2007

Presents summary findings from the first in-depth statewide poll of California parents on school-based comprehensive sex education.

Food and Beverage Marketing on California High School Campuses Survey: Findings and Recommendations

March 1, 2006

Assesses marketing of food and beverages at 20 California public high schools. Provides recommendations for eliminating commercial influences that promote unhealthy foods and beverages, consumer education, and establishing business partnership guidelines.

Advancing the State of the Art in Community Benefit: A User's Guide to Excellence and Accountability

November 1, 2004

Outlines a set of uniform standards and principles to enhance nonprofit hospital efforts to address the underlying causes of health problems in low-income, and ethnically and culturally diverse communities.