Education

  • The importance of including healthy habits in education programs

    Why is it important that education programs include lessons on healthy lifestyle habits?

    We talk so much about reading and literacy in global education, but that is just one part of a child’s life. If we want to look at development in a holistic way, we have to look at a child in his or her entirety, not just his or her academic ability. There is plenty of evidence out there that shows that schools with better sanitary conditions attract more children. Parents vote with their feet, and if they see a school that is clean, has food and has hand-washing facilities, they are more likely to enroll their child in that school.

    How do you see this kind of integration playing out in global education programs?

    My dream is that we can inject health messages into teachers’ daily lesson planning, especially in primary education. Four major areas of concern are oral hygiene, handwashing and sanitation, malaria prevention and nutrition. Handwashing and proper use of latrines should be part of every school’s daily routine. Research shows that promoting handwashing in students, especially when they first arrive at school, greatly reduces the number of sick days among children.

    In Latin America, proper nutrition is a major issue. Children are eating, but they are not getting the proper nutrients. They tend to eat a lot of junk food that is easily accessible in their neighborhoods.

    Other than teachers, who else can help promote healthy habits in education?

    Part of the magic of FHI 360’s active learning methodology is that we integrate parents’ participation in very specific ways. We have done this by asking parents to help schools provide children with breakfast each morning, and we have engaged parent associations to improve sanitation in schools. By actively engaging parents in daily school routines, they not only participate in the success of the schools, but also learn healthy habits themselves. This takes some of the burden off of teachers.

  • Is Education Overlooking the Needs of Boys?

    In the early 1970s, many people began to question why girls did not seem interested in science and math and were not engaged in sports. Research demonstrated that it wasn’t because girls were incapable. Instead, socialization practices, teacher and parental expectations, and media messages told girls that these areas were “not for them.”

    So, people went into action. Policymakers put legislation like Title IX in place, and companies changed how girls and women were portrayed in textbooks. It took more than ten years, but eventually the situation improved for girls.

    All along, everybody assumed boys were doing just fine. But, current research shows that boys — particularly African-American and Latino boys — are being stigmatized in school. They are falling behind in reading and disengaging from school at a very early age, a trend that has disastrous long-term consequences.

    In a chapter titled “Improving Boys’ Achievement in Early Childhood and Primary Education,” published in Lessons in Educational Equality by Oxford University Press, 2012, we synthesize international research about the difficulties boys experience in school and strategies to remedy the situation. The chapter grows out of research and curricula around raising and educating healthy boys that we’ve been doing since 2000. In brief, we argue that the lack of success young boys are experiencing is a gender equity issue, and it calls for some of the strategies that have worked to address gender equity in girls’ education. As a first step, we recommend restoring early education to its roots: making time for play, social-emotional development and exploration.

    We found that in countries around the world, but especially the United States, even kindergarteners are spending an increasing amount of time being taught or tested in literacy and math. This mandated curriculum leaves little time for child-initiated learning or unstructured play and contributes to a rise in aggression and anxiety in young children. And, importantly, they don’t have the opportunity to develop critical social-emotional skills.

    Diminishing opportunities for play and prosocial learning are especially disastrous for boys. It sets boys up for increased likelihood of violence, lower academic achievement and eventually disproportionately high drop-out rates.

    International research is also finding that societal stereotypes about gender — ideas of what boys and girls are supposed to be like — contribute to boys’ lack of success in school.

    For instance, a focus group of teachers and parents said boys were expected to be strong and to hide their emotions; those who didn’t would suffer a host of consequences such as being bullied and ostracized. They also said that energetic boys were thought to be troublemakers.

    These expectations prevent boys from developing into psychologically healthy young men, and they often leave boys with the sense of being scrutinized, disliked or simply “bad.”

    We recommend that teacher education include discussions about gender attitudes and how they affect the way teachers relate to both boys and girls. Change will require intentional focus and concerted effort. But that kind of effort is possible. After all, advocates changed national policies and scaled up programs for girls a generation ago.

    To be sure, work on behalf of girls is not done. But we can apply some of that movement’s lessons to improving boys’ well-being and success in school. Ultimately, we believe that it is important to understand and meet all children’s needs in the classroom and that effective gender equity benefits both girls and boys.

  • The MAM program – led by FHI 360, GSMF, LSHTM and Health Partners Ghana, and funded by Pfizer – was established in 2007 to help close critical gaps in malaria prevention, treatment and education. Malaria is endemic in all parts of Ghana, with all 24.2 million people at risk. It accounts for over three million outpatient visits annually in the country and 30% of all deaths in children under five. Pregnant women are particularly susceptible to malaria, increasing the risk of severe anemia and death, as well as premature delivery, stillbirth and low birth weight in newborns.

    The MAM program educates Licensed Chemical Sellers (LCSs) – the local health authority and main suppliers of medicines across communities in Ghana – on malaria symptom recognition and treatment approaches. The program also involves community mobilization to educate patients, particularly the high-risk population of pregnant women and children under five, and strengthen their demand for quality care. Over 25% of malaria in Ghana is resistant to widely-available monotherapies. Combination therapies that address resistance issues were also cost-prohibitive for most of the population prior to the program.

    In addition to the barriers of cost and availability, there were also many common misconceptions held by community members and even LCSs. These included:

    • The belief that malaria is a common disease, is not dangerous and does not kill
    • The lack of knowledge that malaria is spread by mosquitoes
    • The impression that malaria is caused by heat, house flies, dirt, hard work or eating fatty/oily foods or unripe mangoes

    To address these issues in a comprehensive way, the MAM program includes health, education and even economic improvement aspects.

    A Licensed Chemical Seller explains how to provide appropriate dosing of malaria drugs based on the client’s age and weight, information she learned through the MAM training course.

    Health

    At the core of the program is reducing malaria-related morbidity and mortality in Ghana’s Ashanti region by improving malaria symptom recognition, treatment and referral. The program contributed to the advocacy that resulted in a declassification of combination anti-malarial drugs by the Ministry of Health. Subsequently, LCSs are now permitted to stock and dispense these drugs, bringing effective treatment into the communities. The program has reduced the time needed to obtain effective treatment by 40%. Through community mobilization, household knowledge of early signs of malaria has increased. Combination therapies are also now the most widely used treatment for malaria, increasing cure rates. The program established links so that community-level data is now being collected, analyzed and fed into the health system, helping to inform decision making at all levels and strengthening the connectivity between LCSs and the District and Regional Health Office.

    Education

    Robust education programs trained 1700 LCSs in Ghana to recognize the symptoms of malaria, refer complicated cases directly to health centers, and provide proper treatment and dosage for those who do not need a referral. As a result of the trainings, participating LCSs were elevated in the community for their expertise in malaria and are now recognized as part of the health system and a source of community-level data on malaria.

    A sign board on the outskirts of Kumasi alerting passer-bys to the dangers of malaria and the importance of prompt treatment.

    Economic Benefits

    There were economic benefits to both the program beneficiaries and the LCSs. Following training and education, participating LCSs became area experts on malaria, which increased traffic and built customer trust, often driving business growth.  The increased business helps to reinforce the value of MAM training and better customer service, making the program more sustainable. Community members also benefited from the program: the MAM program and its partners worked with the National Malaria Control Program (NMCP) to apply for the Affordable Medicines Facility for malaria (AMFm) from the Global Fund for AIDS, Tuberculosis and Malaria. This approach resulted in a price reduction for combination therapy, thus making it affordable for lower-income members of the community. As a direct result, caregivers and mothers are spending less time at home caring for sick family members and more time at work or in income-generating activities.

    Programs like MAM improve lives by addressing more than health. Through the MAM project, LSC program participants have gained powerful expertise and improved their businesses in the process. And program beneficiaries have gained better knowledge of the signs of the disease, while gaining improved access to and lower costs for treatment. Although MAM is a health-centered program, it would not be as successful without a more comprehensive approach.

  • Innovation is key to expanding contraceptive choice

    Contraceptive technology has come a long way, but there is still much more work that needs to be done to increase women’s access to safe and effective contraceptive choices.

    Since Margaret Sanger overturned anti-contraceptive legislation in 1936, making it legal for doctors to provide diaphragms and spermicides to women, researchers have been working to develop improved contraceptive methods. Oral contraceptives were introduced to the public in the 1960s and paved the way for future innovation. Today, contraceptive hormones are delivered in a variety of ways, including through implants, long-acting injections, patches and vaginal rings.

    Yet there is still a gap in contraceptive technology that FHI 360 is working to fill – an effective, safe, easy-to-use, and low-cost vaginal contraceptive.

    FHI 360 has developed a new vaginal insert, made of soft, non-woven textile materials that can contain different types of vaginal gels. What makes this insert innovative is that it virtually eliminates leakage of the vaginal gel, a critical issue for both effectiveness and acceptability. The insert is packaged as a single-use, ready-to-use product, pre-moistened with medicated gel. Depending upon the type of gel, the device could be used to prevent pregnancy or HIV or to treat vaginal infections.

    Currently, the only over-the-counter vaginal contraceptives that are available are detergent-based spermicides containing nonoxynol-9 or similar agents. Detergent-based spermicides are irritating to vaginal tissues and with frequent use can cause ulcerations that could increase the risk of HIV infection.

    The insert could be used with new non-irritating spermicides such as BufferGel® (developed by researchers at Johns Hopkins University) or with a ferrous gluconate formulation (developed by researchers at Cornell University). So far, the Hopkins and Cornell researchers have used other delivery methods, including diaphragms and vaginal rings, for their formulations. The FHI 360 insert could also be used to deliver microbicide gels, considered to be one of the most promising interventions to emerge over the past decade to prevent HIV infection in women.

    Results of a pivotal study, presented on September 17 at the Reproductive Health 2011 conference, showed that the combination of BufferGel and the new SILCS® diaphragm—a one-size-fits-all device—was as effective as a diaphragm with nonoxynol-9 gel. This is a double dose of innovation—a new, non-irritating spermicidal gel and a new one-size-fits-all diaphragm—and it’s great news for women.

    In 2009, we conducted a Phase I study to assess the acceptability of the FHI 360 insert among women and their male partners in Durban, South Africa, using the device saturated with 10 mL of an FDA-approved vaginal lubricant. We recruited 40 women, who first inserted and removed the device at the clinic and then at home. For home use, we asked women to discuss the product with their male partner and—if their partner agreed—to wear it during intercourse.

    Participants found the insert easy to place in the vagina and easy to remove with minimal to non-existent leakage. Most men (34) agreed to have intercourse with the device in place. Participants reported that the insert was comfortable during intercourse. Most women said they would be willing to use the insert for contraception or preventing sexually transmitted infections, including HIV, and most men said they would approve of their female partners using it if it became commercially available.

    Once again, we have the potential to advance women’s health in the U.S. and around the world. This is what innovation is all about – improving lives.