Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua

Abstract Background The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery. Methods We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother’s locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women’s characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country. Results Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (β = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (β = − 0.130, 95% CI -0.23, − 0.03) more than in the comparison group. Conclusions Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities’ capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.

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Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

British Journal of General Practice ◽

10.3399/bjgp19x704573 ◽

2019 ◽

Vol 69 (686) ◽

pp. e595-e604 ◽

Cited By ~ 40

Author(s):

Victoria Hammersley ◽

Eddie Donaghy ◽

Richard Parker ◽

Hannah McNeilly ◽

Helen Atherton ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Technical Problems ◽

Face To Face ◽

Information Giving ◽

Care Services ◽

Primary Care Services ◽

Quasi Experimental ◽

Primary Care Clinicians

BackgroundGrowing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice.AimTo explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice.Design and settingComparison of audio-recordings of follow-up consultations in UK primary care.MethodPrimary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use.ResultsOf the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items.ConclusionVC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.

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The impact of meningitis on the motor function of adult survivors in Harare, Zimbabwe

South African Journal of Physiotherapy ◽

10.4102/sajp.v55i1.552 ◽

1999 ◽

Vol 55 (1) ◽

pp. 6-10

Author(s):

Jennifer Jelsma ◽

Helen Lilley ◽

Helen Smith ◽

Jens Mielke ◽

James Hakim ◽

...

Keyword(s):

Functional Disability ◽

Functional Limitation ◽

Adult Survivors ◽

Stepwise Logistic Regression ◽

Motor Impairments ◽

Forward Stepwise ◽

The One ◽

A Prospective Study ◽

The Impact

Objective: The study aimed to document the spectrum of motor impairments and the degree of functional limitation of those who survived adult meningitis and to identify which factors were associated with a poor functional outcome and mortality.Methods: A prospective study was undertaken in the central hospitals in Harare, Zimbabwe. Twenty six adult patients who had survived meningitis were interviewed between one and five months post-admission. Seventeen of these were examined in the clinic for signs of impairment. Nine did not attend the follow-up session and were interviewed at home. The Barthel Activities of Daily Living Index (BI) was administered to all twenty six subjects.Results: Twenty subjects were HIV sero-positive. Eight subjects died in the time period between the one month interview and the final follow-up five months later. The majority of the seventeen examined in the clinic, demonstrated sensory and motor disturbances. Seven of the twenty six subjects scored eighteen or less on the BI. Forward stepwise logistic regression revealed that a low BI was the only variable which significantly predicted mortality (p.<0.01). The odds of a patient with a low BI dying were 63 times the odds of a patient dying who had a normal BI.Discussion and Conclusions: Survivors of meningitis in this study displayed a diversity of impairments and disabilities. Rehabilitation intervention is recommended to provide functional reeducation and support for those with a low BI and to mitigate against the effects of the impairments. A measure of functional disability should be included in the examination of these clients as functional impairment appears to be a predictor of mortality.

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Autoantibody Formation and Alloimunization in Sickle Cell Disease Patients.

Blood ◽

10.1182/blood.v104.11.4099.4099 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4099-4099

Author(s):

Marcia C.Z. Novaretti ◽

Eduardo Jens ◽

Thiago Pagliarini ◽

Andreia L. Rodrigues ◽

Pedro E. Dorlhiac-Llacer ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Study Group ◽

Cell Disease ◽

The One ◽

Design And Methods ◽

The Impact ◽

Transfusion History ◽

Autoantibody Formation

Abstract Background: Alloantibody and autoantibody formation to red blood cell (RBC) antigens is one of the observed complications in sickle cell disease patients (SCD). The incidence of alloimmunization and autoantibodies in this selected group of patients is particularly high, although the clinical implication of autoantibodies in sickle cell disease patients is not clear. The purpose of this study is to evaluate the rate of alloantibody and autoantibody formation in SCD patients. Study design and methods: A retrospective analysis of transfused sickle cell disease patients followed at Fundacao Pro-Sangue Hemocentro de Sao Paulo between 1988 and 2004 were retrieved. Data on transfusion history, were correlated with development of alloantibodies and autoantibodies. Results: The study group was composed by 43 sickle cell disease patients followed for a mean of 89 months (22–116). The number of RBC units transfused (mean) was 64 (4–208). The development of the first alloantibody was detected after a mean of 40 months (1–107) after the first transfusion in our institution. Out of these patients, 31 (72.1%) were identified with RBC alloantibodies; 9 of these patients (21%) had both allo and autoantibodies to RBC antigens, whereas 5 (55.6%) developed autoantibodies after alloimmunization. The one remainder had only autoantibodies. Conclusion: The alloimmunization rate was extremely high (72.1%) and can be partially explained because of the extended time of follow-up (mean of 89 months). Different from the literature the development of autoantibodies preceeded alloantibodies in 44.4%. The impact of this observation in clinical practice warrants further investigation.

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The Impact of “Girls on the Run” on Self-Concept and Fat Attitudes

Journal of Clinical Sport Psychology ◽

10.1123/jcsp.3.2.127 ◽

2009 ◽

Vol 3 (2) ◽

pp. 127-138 ◽

Cited By ~ 13

Author(s):

Jeffrey J. Martin ◽

Jennifer J. Waldron ◽

Andria McCabe ◽

Yun Seok Choi

Keyword(s):

Well Being ◽

Self Esteem ◽

Self Concept ◽

Girls On The Run ◽

Quasi Experimental ◽

Within Subjects ◽

Fear Of Fat ◽

The Impact ◽

Mental Well Being

The purpose of our quasi-experimental study was to examine the impact of the Girls on the Run (GOTR) program on multidimensional self-concept and attitudes toward fat. Young girls (N= 21) participated in a 12-week running program designed to increase their running ability, self-esteem, and, in general, their emotional, social, and mental well-being. It was hypothesized that girls would experience favorable changes in their global self-esteem, appearance, peer, physical, and running self-concepts and their attitudes toward fat. The overall RM-ANOVA examining for pre to post differences was significant, F(13, 8) = 26.46, p < .001, η2 = .977, and follow-up within subjects contrasts revealed three significant differences: Physical, F(1, 20) = 6.24, p < .02, η2 = .24, and running self-concept, F(1, 20) = 11.18, p< .003, η2 = .36, as well as fear of fat, F(1, 20) = 4.37, p < .049, η2 = .18, were all significant with meaningful effect sizes. These findings provided preliminary support for the major goal of the GOTR program, enhancing physical and running self-concept with some support for secondary gains in nonphysical ability areas (i.e., reductions in fear of fat).

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The Impact of a Workshop on Athletic Training Students’ Sport Psychology Behaviors

The Sport Psychologist ◽

10.1123/tsp.23.4.504 ◽

2009 ◽

Vol 23 (4) ◽

pp. 504-522 ◽

Cited By ~ 8

Author(s):

Damien Clement ◽

Vanessa Shannon

Keyword(s):

Athletic Training ◽

Sport Psychology ◽

Repeated Measures ◽

Control Group ◽

Psychological Skills ◽

Athletic Training Students ◽

Time Interaction ◽

Quasi Experimental ◽

The Impact

The current study’s primary purpose was to determine the impact of a sport psychology workshop on athletic training students’ sport psychology behaviors. Using a quasi-experimental research design, partial randomization was used to assign athletic training students (n = 160) to a treatment group or control group. A 2 × 2 repeated measures MANOVA revealed a significant multivariate effect for Group x Time interaction [Wilks’s Λ = .22, F (5, 154) = 1, p < .001, η2 = .77]. Follow up ANOVAs revealed significant interactions for all sport psychology behaviors (allp < .01) except referring an injured athlete to a sport psychologist. Results from the current study revealed that members of the experimental group reported a significant increase in their use of total sport psychology behaviors at the six week follow-up when compared with those in the control group. Such increases highlight the need for increased exposure of athletic training students to sport psychology. Given the potential benefits that could be derived from the incorporation of sport psychology skills and techniques into injury rehabilitation by athletic training students’, the assertion that injured athletes’ physical rehabilitation could be enhanced with the incorporation of psychological skills and techniques appears to be supported.

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Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys

PLoS ONE ◽

10.1371/journal.pone.0242325 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242325

Author(s):

Mohammad Habibullah Pulok ◽

Gowokani Chijere Chirwa ◽

Jacob Novignon ◽

Toshiaki Aizawa ◽

Marshall Makate

Keyword(s):

Health Facility ◽

Socioeconomic Inequality ◽

Care Service ◽

Skilled Birth Attendance ◽

Household Wealth ◽

Facility Delivery ◽

Delivery Care ◽

Health Facility Delivery ◽

Care Services ◽

Birth Attendance

Background Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. Methods This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. Results We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. Conclusion This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

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Human trafficking survivors, after care services, and institutional betrayal : a qualitative perspective on the effectiveness of a victim advocacy program

10.32469/10355/61971 ◽

2017 ◽

Author(s):

◽

Jodi L. Williams

Keyword(s):

Human Trafficking ◽

Secondary Trauma ◽

Trauma Theory ◽

Betrayal Trauma ◽

Victim Advocacy ◽

Care Services ◽

After Care ◽

The One ◽

Advocacy Program ◽

The Impact

This qualitative study was designed to evaluate the effectiveness of the Missouri Sheriff's Association Victim Advocacy Program in rehabilitating human trafficking survivors. The conceptual framework for this study includes betrayal trauma theory and, more specifically, institutional betrayal. Betrayal trauma theory expounds on the posttraumatic effects of trauma on persons when betrayal occurs in an attachment relationship; the concept of institutional betrayal builds on this theory and outlines the significance of an institution betraying an individual who trusts or depends upon that institution just as they would another person (Parnitzke, Smith, and Freyd, 2014). Data collected from the one-on-one interviews will provide a more thorough understanding of human trafficking survivors and will be coded for consistencies and emerging themes in terms of trauma, betrayal, and after care. The aftermath survivors experience will be examined through the lens of institutional betrayal, specifically focusing on the services provided by the Victim Advocacy Program. This data will increase understanding of human trafficking, the impact of secondary trauma of betrayal, and why effective after care services are crucial.

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Multiple Intelligences (MI) on Developing Speaking Skills

English Language in Focus (ELIF) ◽

10.24853/elif.1.2.127-136 ◽

2019 ◽

Vol 1 (2) ◽

pp. 127

Author(s):

Shelawati Rizqiningsih ◽

Muhamad Sofian Hadi

Keyword(s):

Multiple Intelligences ◽

Junior High School ◽

9Th Grade ◽

Post Test ◽

Quasi Experimental ◽

The One ◽

The Individual ◽

The Impact ◽

Group Post ◽

Speaking Skills

The current study investigates the impact of multiple intelligences-based Instructions on developing speaking skills of the students of English. Therefore, the problem of the current study can be stated in the lack of speaking skills of the students of English school in Junior High School, MTs Al-Ihsan Jakarta Barat. To confront this problem, the researcher developed a multiple intelligences-based program to enhance the speaking skills paying due attention to the individual differences among students. The sample of the study consisted of sixty fourth-year perspective students of English. The Quasi-experimental research design was used in the study as the researcher used the one group post-test to assess the usefulness of using this approach. Results of the study proved the effectiveness of Multiple Intelligences-(MI) On Developing Speaking Skills of the 9th Grade Students’ of MTs Al-Ihsan Jakarta Barat.

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Utilization of health facility delivery services in the Jomoro District of the Western Region of Ghana

Second Edition in 2020 of the HSI Journal Volume 1 Issue 2 Publication - Health Sciences Investigations Journal ◽

10.46829/hsijournal.2021.6.2.1.173-180 ◽

2021 ◽

Vol 2 (1) ◽

pp. 173-180

Author(s):

Samuel Nyarko ◽

Anthony Kusi ◽

Kwabena Opoku - Mensah

Keyword(s):

Developing Countries ◽

Maternal Mortality ◽

Health Facility ◽

Facility Delivery ◽

Delivery Care ◽

Western Region ◽

Health Facility Delivery ◽

Skilled Delivery ◽

Care Services ◽

Delivery Services

Background: In the year 2000, member states of the United Nations pledged to work towards a three-quarters reduction in the 1990 maternal mortality ratio by 2015 in line with Millenium. Development Goal 5, but this could not be achieved. This pledge became imperative given the high maternal mortality being recorded, especially among developing countries. The high maternal deaths in developing countries have been attributed partly to the lack of access to skilled birth attendants during delivery. Objective: This study aimed to investigate factors that influence the utilization of health facility delivery services among pregnant women in the Jomoro District of the Western Region of Ghana. Methods: The study used data from a cross-sectional survey among women aged 18 - 49 yr. living in the Jomoro District of Ghana and had given birth between 2012 and 2016 (n = 374). The study participants were randomly selected from women who attended child welfare clinics on clinic days with their babies in eighteen communities. The study used a structured questionnaire to solicit for information about the women’s demographic and socio-economic characteristics, community characteristics and health systems factors likely to influence their decision to seek skilled delivery care as well as their experiences relating to their last delivery. Bivariate analyses were performed between the primary dependent variable and background characteristics of the respondents. Factors influencing the choice of place of delivery were estimated by multiple logistic regression analysis. Data analysis was performed using STATA Statistical Software, Release 14. Results: About 61.0% (n= 228/374) of the women had their last delivery at a health facility while the remaining 38.8% (n= 145/374) delivered at home without skilled assistance. In multivariate analysis, women aged 25 – 29 yr. were less likely to have a skilled delivery (aOR, 0.40; 95% CI: 0.17 - 0.93). Also, professional women had 4.77 odds of having skilled delivery (aOR, 4.77; 95% CI: 1.53 - 14.93). Distance to the nearest health facility also had a statistically significant association with skilled delivery. Women living at 10 – 19 km to a health facility were less likely to have a skilled delivery (aOR, 0.56; 95% CI: 0.32 - 0.97). In addition, the presence of a midwife at a health facility increased the odds of skilled delivery among women (aOR, 4.59; 95% CI: 2.47 - 8.55). Conclusion: Interventions aimed at increasing the uptake of delivery care services to achieve the SDG’s target on maternal mortality must consider improving the socio-economic wellbeing of women in addition to removing the physical and health system barriers impeding access and utilisation of delivery care services.

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Savings ownership and the use of maternal health services in Indonesia

Health Policy and Planning ◽

10.1093/heapol/czz094 ◽

2019 ◽

Vol 34 (10) ◽

pp. 752-761

Author(s):

Soyoon Weon ◽

David W Rothwell ◽

Shailen Nandy ◽

Arijit Nandi

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Facility ◽

Care Delivery ◽

Maternal Health Services ◽

Reproductive Age ◽

Percentage Points ◽

The Impact ◽

Use Of Health Services

Abstract In low- and middle-income countries (LMICs), many women of reproductive age experience morbidity and mortality attributable to inadequate access to and use of health services. Access to personal savings has been identified as a potential instrument for empowering women and improving access to and use of health services. Few studies, however, have examined the relation between savings ownership and use of maternal health services. In this study, we used data from the Indonesian Family Life Survey to examine the relation between women’s savings ownership and use of maternal health services. To estimate the effect of obtaining savings ownership on our primary outcomes, specifically receipt of antenatal care, delivery in a health facility and delivery assisted by a skilled attendant, we used a propensity score weighted difference-in-differences approach. Our findings showed that acquiring savings ownership increased the proportion of women who reported delivering in a health facility by 22 percentage points [risk difference (RD) = 0.22, 95%CI = 0.08–0.37)] and skilled birth attendance by 14 percentage points (RD = 0.14, 95%CI = 0.03–0.25). Conclusions were qualitatively similar across a range of model specifications used to assess the robustness of our main findings. Results, however, did not suggest that savings ownership increased the receipt of antenatal care, which was nearly universal in the sample. Our findings suggest that under certain conditions, savings ownership may facilitate the use of maternal health services, although further quasi-experimental and experimental research is needed to address threats to internal validity and strengthen causal inference, and to examine the impact of savings ownership across different contexts.

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