Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa. Health education for microcredit clients in Peru: a randomized controlled trial Integrating group counseling, cell phone messaging, and participant-generated songs and dramas into a microcredit program increases Nigerian women's adherence to international breastfeeding recommendations. An equity analysis of performance-based financing in Rwanda: are services reaching the poorest women? A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women Leveraging microfinance to impact HIV and financial behaviors among adolescents and their mothers in West Bengal: a cluster randomized trial Utilizing a family-based economic strengthening intervention to improve mental health wellbeing among female adolescent orphans in Uganda Understanding the impact of a microfinance-based intervention on women's empowerment and the reduction of intimate partner violence in South Africa. Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: results from a demand-side financing intervention Efficacy of a savings-led microfinance intervention to reduce sexual risk for HIV among women engaged in sex work: a randomized clinical trial. A cluster randomised controlled trial of the community effectiveness of two interventions in rural Malawi to improve health care and to reduce maternal, newborn and infant mortality On Bathwater, Babies, and Designing Programs for Impact: Evaluations of the Integrated Community Case Management Strategy in Burkina Faso, Ethiopia, and Malawi The impact of a comprehensive microfinance intervention on depression levels of AIDS-orphaned children in Uganda. Integrated maternal and child health services in Mozambique: structural health system limitations overshadow its effect on follow-up of HIV-exposed infants A 2-year integrated agriculture and nutrition and health behavior change communication program targeted to women in Burkina Faso reduces anemia, wasting, and diarrhea in children 3-12.9 months of age at baseline: a cluster-randomized controlled trial. Microfinance for women at high risk for HIV in Kazakhstan: study protocol for a cluster-randomized controlled trial
OBJECTIVE To explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone . METHODS Cross-sectional data were derived from three r and omly selected matched clusters in rural South Africa : ( i ) four villages with 2-year exposure to the Intervention with Microfinance for AIDS and Gender Equity ( IMAGE ) , a combined microfinance-health training intervention ; ( ii ) four villages with 2-year exposure to microfinance services alone ; and ( iii ) four control villages not targeted by any intervention .  Adjusted risk ratios ( aRRs ) employing village-level summaries compared associations between groups in relation to indicators of economic well-being , empowerment , intimate partner violence ( IPV ) and HIV risk behaviour . The magnitude and consistency of aRRs allowed for an estimate of incremental effects . FINDINGS A total of 1409 participants were enrolled , all female , with a median age of 45 . After 2 years , both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group . However , only the IMAGE group demonstrated consistent associations across all domains with regard to women 's empowerment , intimate partner violence and HIV risk behaviour . CONCLUSION The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits . Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance Background Poverty , lack of female empowerment , and lack of education are major risk factors for childhood illness worldwide . Microcredit programs , by offering small loans to poor individuals , attempt to address the first two of these risk factors , poverty and gender disparity . They provide clients , usually women , with a means to invest in their businesses and support their families . This study investigates the health effects of also addressing the remaining risk factor , lack of knowledge about important health issues , through r and omization of members of a microcredit organization to receive a health education module based on the World Health Organization 's Integrated Management of Childhood Illness ( IMCI ) community intervention . Methods Baseline data were collected in February 2007 from clients of a microcredit organization in Pucallpa , Peru ( n = 1,855 ) and their children ( n = 598 ) . Loan groups , consisting of 15 to 20 clients , were then r and omly assigned to receive a health education intervention involving eight monthly 30-minute sessions given by the organization 's loan officers at monthly loan group meetings . In February 2008 , follow-up data were collected , and included assessment s of sociodemographic information , knowledge of child health issues , and child health status ( including child height , weight , and blood hemoglobin levels ) . To explore the effects of treatment ( i.e. , participation in the health education sessions ) on the key outcome variables , multivariate regressions were implemented using ordinary least squares . Results Individuals in the IMCI treatment arm demonstrated more knowledge about a variety of issues related to child health , but there were no changes in anthropometric measures or reported child health status . Conclusions Microcredit clients r and omized to an IMCI educational intervention showed greater knowledge about child health , but no differences in child health outcomes compared to controls . These results imply that the intervention did not have sufficient intensity to change behavior , or that microcredit organizations may not be an appropriate setting for the administration of child health educational interventions of this type . Trial Registration This study is registered with Clinical Trials.gov , NCT01047033 In northern Nigeria , interventions are urgently needed to narrow the large gap between international breastfeeding recommendations and actual breastfeeding practice s. Studies of integrated microcredit and community health interventions documented success in modifying health behaviors but typically had uncontrolled design s. We conducted a cluster-r and omized controlled trial in Bauchi State , Nigeria , with the aim of increasing early breastfeeding initiation and exclusive breastfeeding among female microcredit clients . The intervention had 3 components . Trained credit officers led monthly breastfeeding learning sessions during regularly scheduled microcredit meetings for 10 mo . Text and voice messages were sent out weekly to a cell phone provided to small groups of microcredit clients ( 5 - 7 women ) . The small groups prepared songs or dramas about the messages and presented them at the monthly microcredit meetings . The control arm continued with the regular microcredit program . R and omization occurred at the level of the monthly meeting groups . Pregnant clients were recruited at baseline and interviewed again when their infants were aged ≥6 mo . Logistic regression models accounting for clustering were used to estimate the odds of performing recommended behaviors . Among the clients who completed the final survey ( n = 390 ) , the odds of exclusive breastfeeding to 6 mo ( OR : 2.4 ; 95 % CI : 1.4 , 4.0 ) and timely breastfeeding initiation ( OR : 2.6 ; 95 % CI : 1.6 , 4.1 ) were increased in the intervention vs. control arm . Delayed introduction of water explained most of the increase in exclusive breastfeeding among clients receiving the intervention . In conclusion , a breastfeeding promotion intervention integrated into microcredit increased the likelihood that women adopted recommended breastfeeding practice s. This intervention could be scaled up in Nigeria , where local organizations provide microcredit to > 500,000 clients . Furthermore , the intervention could be adopted more widely given that > 150 million women , many of childbearing age , are involved in microfinance globally Maternal health services continue to favour the wealthiest in lower and middle income countries . Debate about the potential of performance-based financing ( PBF ) to address these disparities continues . As PBF is adopted by countries , it is critical to underst and the equity effects for maternal services . The aim of this study is to examine the effects of PBF on equity in maternal health service use when no specific provisions target the poorest in the population . In Rw and a , PBF was design ed to increase health service use , which was universally low . Paired districts were r and omly assigned to intervention and control for PBF implementation . Using Rw and a 's Demographic Health Survey data from 2005 ( pre-intervention ) and 2007 - 8 ( post-intervention ) , a cluster-level panel data set of 7899 women 15 - 49 years of age from intervention ( 4477 ) and control districts ( 3422 ) was created . The impact of PBF on reported use of facility deliveries , antenatal care ( ANC ) and modern contraceptive use was estimated using a difference-in-differences model with community fixed effects . Interaction terms between wealth quintiles and PBF were estimated to identify the differential effect of PBF among poorer women . The probability of a facility delivery increased by 10 percentage points in the intervention when compared with the control districts ( P = 0.014 ) , while no significant effects were noted for ANC visits or modern contraceptive use . Service use increased for intervention and control population s and across all wealth quintiles from 2005 to 2007 , with no evidence that PBF was a pro-poor or a pro-rich strategy . Insurance remained a positive predictor of service use . This research suggests that if service use is uniformly low then a PBF programme that incentivizes select services , such as facility deliveries , may improve service use overall . However , if the equity gap is extreme , then a PBF programme without equity targets will do little to alleviate disparities Objective : To assess effects of a combined microfinance and training intervention on HIV risk behavior  among young female participants in rural South Africa . Design : Secondary analysis of quantitative and qualitative data from a cluster r and omized trial , the Intervention with Microfinance for AIDS and Gender Equity study . Methods : Eight villages were pair-matched and r and omly allocated to receive the intervention . At baseline and after 2 years , HIV risk behavior was assessed among female participants aged 14–35 years . Their responses were compared with women of the same age and poverty group from control villages . Intervention effects were calculated using adjusted risk ratios employing village level summaries . Qualitative data collected during the study explored participants ' responses to the intervention including HIV risk behavior . Results : After 2 years of follow-up , when compared with controls , young participants had higher levels of HIV-related communication ( adjusted risk ratio 1.46 , 95 % confidence interval 1.01–2.12 ) , were more likely to have accessed voluntary counseling and testing ( adjusted risk ratio 1.64 , 95 % confidence interval 1.06–2.56 ) , and less likely to have had unprotected sex at last intercourse with a nonspousal partner ( adjusted risk ratio 0.76 , 95 % confidence interval 0.60–0.96 ) . Qualitative data suggest a greater acceptance of intrahousehold communication about HIV and sexuality . Although women noted challenges associated with acceptance of condoms by men , increased confidence and skills associated with participation in the intervention supported their introduction in sexual relationships . Conclusions : In addition to impacts on economic well being , women 's empowerment and intimate partner violence , interventions addressing the economic and social vulnerability of women may contribute to reductions in HIV risk behavior Background African American women are at increased risk for poor pregnancy outcomes compared to other racial-ethnic groups . Single or multiple psychosocial and behavioral factors may contribute to this risk . Most interventions focus on singular risks . This paper describes the design , implementation , challenges faced , and acceptability of a behavioral counseling intervention for low income , pregnant African American women which integrated multiple targeted risks into a multi-component format . Methods Six academic institutions in Washington , DC collaborated in the development of a community-wide , primary care research study , DC-HOPE , to improve pregnancy outcomes . Cigarette smoking , environmental tobacco smoke exposure , depression and intimate partner violence were the four risks targeted because of their adverse impact on pregnancy . Evidence -based models for addressing each risk were adapted and integrated into a multiple risk behavior intervention format . Pregnant women attending six urban prenatal clinics were screened for eligibility and risks and r and omized to intervention or usual care . The 10-session intervention was delivered in conjunction with prenatal and postpartum care visits . Descriptive statistics on risk factor distributions , intervention attendance and length ( i.e. , with < 4 sessions considered minimal adherence ) for all enrolled women ( n = 1,044 ) , and perceptions of study participation from a sub- sample of those enrolled ( n = 152 ) are reported . Results Forty-eight percent of women screened were eligible based on presence of targeted risks , 76 % of those eligible were enrolled , and 79 % of those enrolled were retained postpartum . Most women reported a single risk factor ( 61 % ) ; 39 % had multiple risks . Eighty-four percent of intervention women attended at least one session ( 60 % attended ≥ 4 sessions ) without disruption of clinic scheduling . Specific risk factor content was delivered as prescribed in 80 % or more of the sessions ; 78 % of sessions were fully completed ( where all required risk content was covered ) . Ninety-three percent of the sub sample of intervention women had a positive view of their relationship with their counselor . Most intervention women found the session content helpful . Implementation challenges of addressing multiple risk behaviors are discussed . Conclusion While implementation adjustments and flexibility are necessary , multiple risk behavioral interventions can be implemented in a prenatal care setting without significant disruption of services , and with a majority of referred African American women participating in and expressing satisfaction with treatment sessions Abstract Microfinance can be used to reach women and adolescent girls with HIV prevention education . We report findings from a cluster-r and omized control trial among 55 villages in West Bengal to determine the impact of non-formal education on knowledge , attitudes and behaviors for HIV prevention and savings . Multilevel regression models were used to evaluate differences between groups for key outcomes while adjusting for cluster correlation and differences in baseline characteristics . Women and girls who received HIV education  showed significant gains in HIV knowledge , awareness that condoms can prevent HIV , self-efficacy for HIV prevention , and confirmed use of clean needles , as compared to the control group . Condom use was rare and did not improve for women . While HIV testing was uncommon , knowledge of HIV-testing re sources significantly increased among girls , and trended in the positive direction among women in intervention groups . Conversely , the savings education showed no impact on financial knowledge or behavior change Background It is estimated that almost 20 % of the world ’s adolescents have experienced or are experiencing a mental health problem . Several factors have been associated with the onset of adolescent mental health disorders , including poverty , child abuse and violence , particularly among adolescent girls . This paper examines the effect of participating in a family-based economic strengthening intervention on the mental health well-being of female adolescent orphans impacted by HIV/AIDS in rural Ug and a. Methods Data utilized in this study was from the Bridges to the Future Study ( 2011–2016 ) , an economic empowerment intervention aim ed at improving health outcomes of orphaned children . Adolescents were r and omly assigned to either the control condition receiving bolstered st and ard of care services for orphaned adolescents ; or one of two treatment conditions receiving bolstered st and ard of care as well as an economic empowerment intervention comprising of a child development account , a mentorship program and workshops on financial management and microenterprise development . Data was collected at baseline , 12- and 24-months post intervention initiation . Multilinear regression analyses were conducted to examine the impact of an economic empowerment intervention on mental health functioning of female participants over time . Mental health functioning was measured by : ( 1 ) the Child Depression Inventory ; ( 2 ) Beck Hopelessness Scale ; and ( 3 ) Tennessee Self Concept Scale . Results Analysis results show an improvement in mental health functioning over time among female participants receiving the intervention compared to their control counterparts . Specifically , compared to participants in the control condition , participants receiving the intervention reported a reduction in depressive symptoms from baseline to 12-months follow-up ( b = − 1.262 , 95 % CI − 2.476 , − 0.047 ) , and an additional 0.645-point reduction between baseline and 24-months follow-up ( b = − 1.907 , 95 % CI − 3.192 , − 0.622 ) . Participants receiving the intervention reported significant improvement in their reported self-concept from baseline to 24 months follow-up ( b = 3.503 ( 95 % CI 1.469 , 5.538 ) compared to participants in the control condition . Conclusions Empowerment of young girls , either in the form of peer mentorship and /or economic strengthening seems to significantly improve the overall mental health functioning of adolescent girls impacted by HIV and AIDS in low-income setting OBJECTIVES We sought to obtain evidence about the scope of women 's empowerment and the mechanisms underlying the significant reduction in  intimate partner violence  documented by the Intervention With Microfinance for AIDS and Gender Equity ( IMAGE ) cluster-r and omized trial in rural South Africa . METHODS The IMAGE intervention combined a microfinance program with participatory training on underst and ing HIV infection , gender norms , domestic violence , and sexuality . Outcome measures included past year 's experience of intimate partner violence and 9 indicators of women 's empowerment . Qualitative data about changes occurring within intimate relationships , loan groups , and the community were also collected . RESULTS After 2 years , the risk of past-year physical or sexual violence by an intimate partner was reduced by more than half ( adjusted risk ratio=0.45 ; 95 % confidence interval=0.23 , 0.91 ) . Improvements in all 9 indicators of empowerment were observed . Reductions in violence result ed from a range of responses enabling women to challenge the acceptability of violence , expect and receive better treatment from partners , leave abusive relationships , and raise public awareness about intimate partner violence . CONCLUSIONS Our findings , both qualitative and quantitative , indicate that economic and social empowerment of women can contribute to reductions in intimate partner violence Background Dem and -side financing projects are now being implemented in many developing countries , yet evidence showing that they reach the poor is scanty . Methods A  maternal health voucher scheme provided voucher-paid services in Jhang , a predominantly rural district of Pakistan , during 2010 . A pre-test/post-test quasi-experimental design was used to assess the changes in the proportion of facility-based deliveries and related maternal health services among the poor . Household interviews were conducted with r and omly selected women in the intervention and control union councils , before and after the intervention . A strong outreach model was used . Voucher promoters were given basic training in identification of poor women using the Poverty Scorecard for Pakistan , in the types of problems women could face during delivery , and in the promotion of antenatal care ( ANC ) , institutional delivery and postnatal care ( PNC ) . Voucher booklets valued at Rs . 4,000 ( $ 48 ) , including three ANC visits , a PNC visit , an institutional delivery , and a postnatal family planning visit , were sold for Rs . 100 ( $ 1.2 ) to low-income women targeted by project outreach workers . Women suffering from complications were referred to emergency obstetric care services . Analysis was conducted at the bivariate and the multivariate levels . At the multivariate level , logistic regression analysis was conducted to determine whether the increase in institutional delivery was greater among poor women ( defined for this study as women in the fourth or fifth quintiles ) relative to non-poor women ( defined for this study as women in the first quintile ) in the intervention union councils compared to the control union councils . Results Bivariate analysis showed significant increases in the institutional delivery rate among women in the fourth or fifth wealth quintiles in the intervention union councils but no significant changes in this indicator among women in the same wealth quintiles in the control union councils . Multivariate analysis showed that the increase in institutional delivery among poor women relative to non-poor women was significantly greater in the intervention compared to the control union councils . Conclusions Dem and -side financing projects using vouchers can be an effective way of reducing inequities in institutional delivery OBJECTIVES We tested whether a structural intervention combining savings-led microfinance and HIV prevention components would achieve enhanced reductions in sexual risk among women engaging in street-based sex work in Ulaanbaatar , Mongolia , compared with an HIV prevention intervention alone . METHODS Between November 2011 and August 2012 , we r and omized 107 eligible women who completed baseline assessment s to either a 4-session HIV sexual risk reduction intervention ( HIVSRR ) alone ( n=50 ) or a 34-session HIVSRR plus a savings-led microfinance intervention ( n=57 ) . At 3- and 6-month follow-up assessment s , participants reported unprotected acts of vaginal intercourse with paying partners and number of paying partners with whom they engaged in sexual intercourse in the previous 90 days . Using Poisson and zero-inflated Poisson model regressions , we examined the effects of assignment to treatment versus control condition on outcomes . RESULTS At 6-month follow-up , the HIVSRR plus microfinance participants reported significantly fewer paying sexual partners and were more likely to report zero unprotected vaginal sex acts with paying sexual partners . CONCLUSIONS Findings advance the HIV prevention repertoire for women , demonstrating that risk reduction may be achieved through a structural intervention that relies on asset building , including savings , and alternatives to income from sex work Background The UN Millennium Development Goals call for substantial reductions in maternal and child mortality , to be achieved through reductions in morbidity and mortality during pregnancy , delivery , postpartum and early childhood . The M aiM wana Project aims to test community-based interventions that tackle maternal and child health problems through increasing awareness and local action . Methods / Design This study uses a two-by-two factorial cluster-r and omised controlled trial design to test the impact of two interventions . The impact of a community mobilisation intervention run through women 's groups , on home care , health care-seeking behaviours and maternal and infant mortality , will be tested . The impact of a volunteer-led infant feeding and care support intervention , on rates of exclusive breastfeeding , uptake of HIV-prevention services and infant mortality , will also be tested . The women 's group intervention will employ local female facilitators to guide women 's groups through a four-phase cycle of problem identification and prioritisation , strategy identification , implementation and evaluation . Meetings will be held monthly at village level . The infant feeding intervention will select local volunteers to provide advice and support for breastfeeding , birth preparedness , newborn care and immunisation . They will visit pregnant and new mothers in their homes five times during and after pregnancy . The unit of intervention allocation will be clusters of rural villages of 2500 - 4000 population . 48 clusters have been defined and r and omly allocated to either women 's groups only , infant feeding support only , both interventions  , or no intervention . Study villages are surrounded by ' buffer areas ' of non- study villages to reduce contamination between intervention and control areas . Outcome indicators will be measured through a demographic surveillance system . Primary outcomes will be maternal , infant , neonatal and perinatal mortality for the women 's group intervention , and exclusive breastfeeding rates and infant mortality for the infant feeding intervention . Structured interviews will be conducted with mothers one-month and six-months after birth to collect detailed quantitative data on care practice s and health-care-seeking . Further qualitative , quantitative and economic data will be collected for process and economic evaluations . Trial registration IS RCT The adage “ do n’t throw the baby out with the bathwater ” advises us not to discard the essential along with the unessential , whether due to impatience or frustration . 1 This issue of the journal includes reports on prospect i ve evaluations of the integrated community case management ( iCCM ) of childhood illness strategy in Burkina Faso , 2 Ethiopia , 3 and Malawi . 4 iCCM seeks to reduce child mortality by making effective treatment of pneumonia , diarrhea , and malaria available from trained health workers at community level . 5 In this commentary , we show results from the three countries , highlighting hard-won lessons about iCCM ’s potential to prevent unnecessary deaths among children . The independent iCCM evaluations were design ed in 2009– 2010 , as a part of the Catalytic Initiative to Save a Million Lives 6 spearheaded by Canada and involving the Bill & Melinda Gates Foundation , the U.K. Department for International Development , the United Nations Children ’s Fund , the World Health Organization , the Doris Duke Charitable Foundation , and others . The goal of the Catalytic Initiative was to support and measure the impact of strong , coordinated efforts to deliver high-impact interventions to reduce  under-five mortality  in low-income , high-burden countries , with a particular focus on providing treatment for childhood pneumonia , diarrhea , and malaria at community level using iCCM . The evaluation in each setting was conducted in collaboration with local research institutions , based on a locally adapted version of the common evaluation framework for maternal , newborn , and child health ( MNCH ) . 7 The evaluation design s were built on impact models reflecting the pathway to child survival . Beginning with policy and program inputs , the pathway moves to project implementation and intermediate outputs such as improved provision of quality services , strengthened health systems , and increased utilization . Continuing to coverage and behavioral outcomes , the pathway culminates in impact of under-five and postneonatal mortality . We focus on  mortality among children aged 2–59 months here , because the iCCM strategy did not include guidelines for children under 2 months of age . Detailed methods are described in the individual papers ; Table 1 provides a summary . All sites documented program inputs and context ual factors that may have affected program implementation or effectiveness . The evaluation teams shared intermediate and final results with governments and partners as a basis for strengthening iCCM implementation . Selected results across the three countries are shown in Table 2 . We reanalyzed some variables to maximize comparability across countries ; in some instances , results presented here are not included in the series papers . iCCM was not associated with accelerated mortality declines  in children aged 2–59 months during the 2- to 4-year evaluation periods in these three setting s. The reasons for this lack of association likely varied across setting s , as does the likelihood that these programs may achieve measureable impact after additional years of sustained implementation . In Burkina Faso , iCCM implementation did not reflect current best practice for design ing and implementing effective MNCH programs . The program relied on community health worker ( CHW ) lay volunteers . The initial training was organized as a “ cascade ” in which representatives from districts were trained and then requested to organize subdistrict-level training sessions to train over 3,000 CHWs in the space of a few months , with minimal support or supervision . The training included written material s even though many of the PURPOSE By adversely affecting family functioning and stability , poverty constitutes an important risk factor for children 's poor mental health functioning . This study examines the impact of a comprehensive microfinance intervention , design ed to reduce the risk of poverty , on depression among AIDS-orphaned youth . METHODS Children from 15 comparable primary schools in Rakai District of Ug and a , one of those hardest hit by HIV/AIDS in the country , were r and omly assigned to control ( n = 148 ) or treatment ( n = 138 ) conditions . Children in the treatment condition received a comprehensive microfinance intervention comprising matched savings accounts , financial management workshops , and mentorship . This was in addition to traditional services provided for all school-going orphaned adolescents ( counseling and school supplies ) . Data were collected at wave 1 ( baseline ) , wave 2 ( 10 months after intervention ) , and wave 3 ( 20 months after intervention ) . We used multilevel growth models to examine the trajectory of depression in treatment and control conditions , measured using Children 's Depression Inventory ( Kovacs ) . RESULTS Children in the treatment group exhibited a significant decrease in depression , whereas their control group counterparts showed no change in depression . CONCLUSIONS The findings indicate that over and above traditional psychosocial approaches used to address mental health functioning among orphaned children in sub-Saharan Africa , incorporating poverty alleviation-focused approaches , such as this comprehensive microfinance intervention , has the potential to improve psychosocial functioning of these children Background The follow-up of HIV-exposed infants remains a public health challenge in many Sub-Saharan countries . Just as integrated antenatal and maternity services have contributed to improved care for HIV-positive pregnant women , so too could integrated care for mother and infant after birth improve follow-up of HIV-exposed infants . We present results of a study testing the viability of such integrated care , and its effects on follow-up of HIV-exposed infants , in Tete Province , Mozambique . Methods Between April 2009 and September 2010 , we conducted a mixed- method , intervention-control study in six rural public primary healthcare facilities , selected purposively for size and accessibility , with r and om allocation of three facilities each for intervention and control groups . The intervention consisted of a reorganization of services to provide one-stop , integrated care for mothers and their children under five years of age .  We collected monthly routine facility statistics on prevention of mother-to-child HIV transmission ( PMTCT ) , follow-up of HIV-exposed infants , and other mother and child health ( MCH ) activities for the six months before ( January-June 2009 ) and 13 months after starting the intervention ( July 2009-July 2010 ) . Staff were interviewed at the start , after six months , and at the end of the study . Quantitative data were analysed using quasi-Poisson models for significant differences between the periods before and after intervention , between healthcare facilities in intervention and control groups , and for time trends . The coefficients for the effect of the period and the interaction effect of the intervention were calculated with their p-values . Thematic analysis of qualitative data was done manually . Results One-stop , integrated care for mother and child was feasible in all participating healthcare facilities , and staff evaluated this service organisation positively . We observed in both study groups an improvement in follow-up of HIV-exposed infants ( registration , follow-up visits , serological testing ) , but frequent absenteeism of staff and irregular supply of consumables interfered with healthcare facility performance for both intervention and control groups . Conclusions Despite improvement in various aspects of the follow-up of HIV-exposed infants , we observed no improvement attributable to one-stop , integrated MCH care . Structural healthcare system limitations , such as staff absences and irregular supply of essential commodities , appear to overshadow its potential effects . Regular technical support and adequate basic working conditions are essential for improved performance in the follow-up of HIV-exposed infants in peripheral public healthcare facilities in Mozambique BACKGROUND Among young children in Burkina Faso , anemia and chronic and acute undernutrition are widespread . OBJECTIVE This study assessed the impact of Helen Keller International 's ( HKI ) 2-y integrated agriculture [ homestead food production ( HFP ) ] and nutrition and health behavior change communication ( BCC ) program , targeted to women , on children 's ( 3 - 12.9 mo old at baseline ) anthropometry ( stunting , wasting , and underweight ) , mean hemoglobin ( Hb ) , anemia ( Hb < 11 g/dL ) , and diarrhea prevalence . METHODS We used a cluster-r and omized controlled trial , with 55 villages r and omly assigned to a control group ( n = 25 ) or 1 of 2 treatment groups ( n = 15 each ) , which differed by who delivered the BCC messages [ older women leaders or health committee ( HC ) members ] . We used difference-in-difference ( DID ) estimates to assess impacts on child outcomes . RESULTS We found marginally significant ( P < 0.10 ) impacts on Hb ( DID : 0.51 g/dL ; P = 0.07 ) and wasting [ DID : -8.8 percentage point ( pp ) ; P = 0.08 ] and statistically significant ( P < 0.05 ) impacts on diarrhea ( -15.9 pp ; P = 0.00 ) in HC compared with control villages among children aged 3 - 12.9 mo and larger impacts for anemia ( DID : -14.6 pp ; P = 0.03 ) and mean Hb ( DID : 0.74 g/dL ; P = 0.03 ) among younger children ( aged 3 - 5.9 mo ) . However , we found no significant impacts on stunting or underweight prevalence . Plausibility was supported by greater improvements in women 's agricultural production and maternal infant and young child feeding and care knowledge and practice s in HC compared with control villages . CONCLUSIONS HKI 's 2-y integrated HFP+BCC program ( HC group ) significantly improved several child outcomes , including wasting ( marginal ) , diarrhea , Hb , and anemia , especially among the youngest children . This is the first cluster-r and omized controlled trial of an HFP program that documents statistically significant positive effects on these child nutrition outcomes . This trial was registered at clinical trials.gov as NCT01825226 Background Among women at high risk for HIV and other sexually transmitted diseases ( STIs ) , gender and economic issues limit the impact of behavioral prevention strategies . Women in Kazakhstan with dual risks of sex trading and drug use face elevated risk for HIV and STIs and may benefit from an economic empowerment intervention which combines HIV-risk reduction ( HIVRR ) education with financial skills-building and asset-building to promote reduced reliance on sex trading for income . Methods / design The study employs a two-arm , cluster-r and omized controlled trial ( c- RCT ) design . We will use cluster r and omization to assign 350 women in approximately 50 cohorts to a traditional four-session HIV-risk-reduction intervention combined with a six-session financial literacy intervention , enrollment in a 24-session vocational training program and receipt of matched savings ( HIVRR+MF ) ; or to the four-session HIV-risk-reduction intervention alone ( HIVRR ) . Repeated behavioral and biological assessment s will be conducted at baseline , then at 6 , 9 , and 15 months post r and omization/session 1 . Discussion This study responds to an identified need in the academic literature for rigorous testing of structural interventions , including combination microfinance and HIV-prevention interventions .Trial registration Clinical Trials.gov , ID : NCT02406482 . Registered on 30 March 2015
Results Most interventions combined microfinance with health education , which demonstrated positive effects on health knowledge and behaviours , though not health status .
Interventions combining multiple health components in a given study demonstrated positive effects , though it was unclear which component was driving the effect .
Discussion Integrated microfinance and health education programs were effective , though longer intervention periods are necessary to measure more complex pathways to health status .
The effect of microfinance combined with other health components was less clear .
Background Solutions delivered within firm sectoral boundaries are inadequate in achieving income security and better health for poor population s.  Integrated microfinance and health interventions leverage networks of women to promote financial inclusion , build livelihoods , and safeguard against high cost illnesses .
Our underst and ing of the effect of integrated interventions has been limited by variability in intervention , outcome , design , and method ological rigour .
This systematic review synthesis es the literature through 2015 to underst and the effect of  integrated microfinance and health programs .