scholarly journals Disrespectful care in family planning services among youth and adult simulated clients in public sector facilities in Malawi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elizabeth Hazel ◽  
Diwakar Mohan ◽  
Ephraim Chirwa ◽  
Mary Phiri ◽  
Fannie Kachale ◽  
...  
Keyword(s):  
Family Planning ◽  
Case Scenario ◽  
Adolescent Women ◽  
Disrespectful Care ◽  
Hiv Test ◽  
Centered Care ◽  
Field Notes ◽  
Quality Assessments ◽  
To Receive

Abstract Background Provision of high-quality family planning (FP) services improves access to contraceptives. Negative experiences in maternal health have been documented worldwide and likely occur in other services including FP. This study aims to quantify disrespectful care for adult and adolescent women accessing FP in Malawi. Methods We used simulated clients (SCs) to measure disrespectful care in a census of public facilities in six districts of Malawi in 2018. SCs visited one provider in each of the 112 facilities: two SCs visits (one adult and one adolescent case scenario) or 224 SC visits total. We measured disrespectful care using a quantitative tool and field notes and report the prevalence and 95% confidence intervals for the indicators and by SC case scenarios contextualized with quotes from the field notes. Results Some SCs (12%) were refused care mostly because they did not agree to receive a HIV test or vaccination, or less commonly because the clinic was closed during operating hours. Over half (59%) of the visits did not have privacy. The SCs were not asked their contraceptive preference in 57% of the visits, 28% reported they were not greeted respectfully, and 20% reported interruptions. In 18% of the visits the SCs reported humiliation such as verbal abuse. Adults SCs received poorer counseling compared to the adolescent SCs with no other differences found. Conclusions We documented instances of refusal of care, lack of privacy, poor client centered care and humiliating treatment by providers. We recommend continued effort to improve quality of care with an emphasis on client treatment, regular quality assessments that include measurement of disrespectful care, and more research on practices to reduce it.

scholarly journals Disrespectful Care in Family Planning Services Among Youth and Adult Simulated Clients in Public Sector Facilities in Malawi.

2020 ◽  
Author(s):  
Elizabeth Hazel ◽  
Diwakar Mohan ◽  
Ephraim Chirwa ◽  
Mary Phiri ◽  
Fannie Kachale ◽  
...  
Keyword(s):  
Family Planning ◽  
Case Scenario ◽  
Adolescent Women ◽  
Disrespectful Care ◽  
Hiv Test ◽  
Centered Care ◽  
Field Notes ◽  
Quality Assessments ◽  
To Receive

Abstract Background Provision of high-quality family planning (FP) services improves access to contraceptives. Negative experiences in maternal health have been documented worldwide and likely occur in other services including FP. This study aims to quantify disrespectful care for adult and adolescent women accessing FP in Malawi. Methods We used simulated clients (SCs) to measure disrespectful care in a census of public facilities in six districts of Malawi in 2018. SCs visited one provider in each of the 112 facilities: two SCs visits (one adult and one adolescent case scenario) or 224 SC visits total. We measured disrespectful care using a quantitative tool and field notes and report the prevalence and 95% confidence intervals for the indicators and by SC case scenarios contextualized with quotes from the field notes. Results Some SCs (12%) were refused care because they did not agree to receive a HIV test or vaccination, or the clinic was closed during operating hours. Over half (59%) of the visits did not have privacy. The SCs were not asked their contraceptive preference in 57% of the visits, 28% reported they were not greeted respectfully, and 20% reported interruptions. In 18% of the visits the SCs reported humiliation such as verbal abuse. Conclusions We documented instances of refusal of care, lack of privacy, poor client centered care and humiliating treatment by providers. We recommend continued effort to improve quality of care with an emphasis on client treatment, regular quality assessments that include measurement of disrespectful care, and more research on practices to reduce it.

scholarly journals Person-centred Quality, Provider Involvement and Family Planning Continuation in India

2020 ◽  
Author(s):  
Nadia Diamond-Smith ◽  
Beth Phillips ◽  
Patience Afulani ◽  
Aradhana Srivast ◽  
Ginger Golub ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Family Planning ◽  
Quality Measures ◽  
Power Dynamics ◽  
Care Experience ◽  
Person Centered Care ◽  
Centered Care ◽  
And Gender ◽  
The Impact

Abstract Background: Quality of care of family planning provision has many dimensions, and measuring and understanding these different components is challenging. Furthermore, understanding which components are most important for women’s experiences and method continuation is essential for improving the quality of care provision. Methods: We use longitudinal data from India to explore the impact of different measures of quality (provider preference, provider involvement, and a newly developed scale of person-centered care experiences) on method continuation. We also look at associations between the quality measures and discuss why different measures may be more salient in different contexts. Results: We find that a woman’s person-centered care experience is not associated with continuation in India. Providers having a strong preference is associated with continuation. Conclusions: Certain measures of person-centered quality appear to impact family planning continuation, but the validated person-centered care measure is not. Socio-cultural factors such as power dynamics and gender norms likely impact expectations, and need to be considered in interpreting and choosing quality measures.

scholarly journals Person-Centred Quality, Provider Involvement and Family Planning Continuation in India

2020 ◽  
Author(s):  
Nadia Diamond-Smith ◽  
Beth Phillips ◽  
Patience Afulani ◽  
Aradhana Srivast ◽  
Ginger Golub ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Family Planning ◽  
Uttar Pradesh ◽  
Power Dynamics ◽  
Care Experience ◽  
Person Centered Care ◽  
Centered Care ◽  
Secondary Objective ◽  
And Gender

Abstract Background: Quality of care of family planning provision has many dimensions, including those related to a woman’s experience, or person-centered care, and measuring and understanding these different components is challenging. Understanding which components are most important for women’s experiences and method continuation is essential for improving the quality of care provision. The objective of this paper is to explore weather a recently developed scale to measure person-centered family planning experiences is associated with method continuation in India. The secondary objective is to compare this scale to other commonly used measures of quality, and if other measures are more associated with continuation. Methods: We use longitudinal data collected from women in Uttar Pradesh, India (N=225 at baseline, N=179 6 weeks later) to explore the association between different measures of quality (provider preference, provider involvement, and a newly developed scale of person-centered care experiences) and method continuation. Results: We find that a woman’s person-centered care experience is not associated with continuation in this population in India. Providers having a strong method preference is associated with continuation. Conclusion: Certain measures of person-centered quality appear to impact family planning continuation, but the validated person-centered care measure is not. Socio-cultural factors such as power dynamics and gender norms likely impact expectations, and need to be considered in interpreting and choosing quality measures.

Lesson Study dan Implikasinya Terhadap Pembelajaran Berbasis Kurikulum Tingkat Satuan Pendidikan

2016 ◽  
Vol 1 ◽  
pp. 189-196
Author(s):  
Vian Harsution
Keyword(s):  
Learning Environment ◽  
Learning Process ◽  
Lesson Study ◽  
Learning Difficulties ◽  
Learning Needs ◽  
Democratic Leadership ◽  
Entrepreneurial Spirit ◽  
To Receive

Lesson study is a systematic, collaborative, and sustainable method of improving the quality of learning. Lesson study emphasizes the exploration of students’ learning needs; teacher openness towards learning difficulties encountered; the willingness of teachers to receive and provide advice and solutions to the difficulties encountered; and the consistency of the various parties to follow up the suggestions and solutions. Implementation of lesson study involving teachers, principals, and experts in the field of education. Kurikulum tingkat satuan pendidikan or abbreviated KTSP is operational curriculum formulated and implemented by each educational unit. KTSP has the characteristics, namely: giving broad autonomy to the educational unit, involving the community and parent participation, involving the democratic leadership of the principal, and require the support of a working team that is synergistic and transparent. KTSP based on the learning process, needs to be supported by a conducive learning environment and fun to be created by teachers.Teachers and principals in a professional, systematic and collaborative create an atmosphere that fosters independence, tenacity, entrepreneurial spirit, adaptive and proactive nature of the learning process. Thus, the learning needs of students who fulfilled optimally and professional ability of teacher who have increased on an ongoing basis, may usher in success – based learning KTSP. It means that the lesson study provides positive implications for the KTSP – based learning.

The Microbial Quality of a Wetland Reclamation Facility Used to Produce an Effluent for Unrestricted non-Potable Reuse

1999 ◽  
Vol 40 (4-5) ◽  
pp. 369-374 ◽  
Author(s):  
R. S. Fujioka ◽  
A. J. Bonilla ◽  
G. K. Rijal
Keyword(s):  
Fecal Coliform ◽  
Heterotrophic Bacteria ◽  
Fecal Indicator ◽  
Potable Reuse ◽  
Wetland Reclamation ◽  
Treated Sewage ◽  
Influent Water ◽  
Human Viruses ◽  
To Receive

An auxiliary Wetland Reclamation Facility (WRF) was constructed to receive stabilization pond treated sewage and further treat it with water hyacinth ponds, chemical flocculation, filtration and ultraviolet light disinfection. This was the first facility in Hawaii which was approved to produce the highest quality reclaimed water using alternative treatment schemes. We assessed the effectiveness of the WRF by monitoring water samples after each of the WRF treatment schemes for five genetically different groups of sewage borne microorganisms (fecal coliform, enterococci, C. perfringens, FRNA phage, total heterotrophic bacteria). The concentrations of all fecal indicator microoganisms, especially FRNA phase were low in the influent water to the WRF indicating that extended pond treatment may be especially effective in removing human viruses from sewage. The WRF treatment scheme was calculated to be able to reduce >99.99% of fecal coliform and therefore was able to produce an effluent meeting the non-potable, unrestricted reuse standard of a geometric means of <1 fecal coliform/100 ml.

Operations Research on the Female Village-Based Family Planning Worker Program of Pakistan

1998 ◽  
Vol 18 (3) ◽  
pp. 283-305
Author(s):  
Louisiana Lush ◽  
George P. Cernada ◽  
A. K. Ubaidur Rob ◽  
Mohammed Shafiq Arif ◽  
Minhaj Ul Haque ◽  
...  
Keyword(s):  
Family Planning ◽  
Operations Research ◽  
Technical Assistance ◽  
Field Studies ◽  
Family Planning Services ◽  
Training And Supervision ◽  
The Government ◽  
And Training ◽  
Broad Program

This article presents the results of a number of operations research studies (OR) of family planning services provided by a new cadre of female village-based family planning workers in Punjab Province, Pakistan. This cadre of workers, recruited nationwide, have been trained to visit women in their villages to provide information and family planning services. The studies were conducted as part of a broad program of technical assistance to the Government of Pakistan. Surveys investigated the quality of their training as well as attitudes among clients to the new program. They found that the program is developing well but there is room for improvement, particularly in counseling and training. Additional field studies are ongoing and recommendations for change have been incorporated in training and supervision. The program is expanding on a national scale.

Prospective Randomized Trial Comparing Mitomycin, Cisplatin, and Protracted Venous-Infusion Fluorouracil (PVI 5-FU) With Epirubicin, Cisplatin, and PVI 5-FU in Advanced Esophagogastric Cancer

2002 ◽  
Vol 20 (8) ◽  
pp. 1996-2004 ◽  
Author(s):  
P. Ross ◽  
M. Nicolson ◽  
D. Cunningham ◽  
J. Valle ◽  
M. Seymour ◽  
...  
Keyword(s):  
Randomized Study ◽  
Squamous Carcinoma ◽  
Undifferentiated Carcinoma ◽  
Palmar Erythema ◽  
Esophagogastric Cancer ◽  
Equivalent Efficacy ◽  
Venous Infusion ◽  
Grade 3 ◽  
To Receive

PURPOSE: We report the results of a prospectively randomized study that compared the combination of epirubicin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) (ECF) with the combination of mitomycin, cisplatin, and PVI 5-FU (MCF) in previously untreated patients with advanced esophagogastric cancer. PATIENTS AND METHODS: Five hundred eighty patients with adenocarcinoma, squamous carcinoma, or undifferentiated carcinoma were randomized to receive either ECF (epirubicin 50 mg/m2 every 3 weeks, cisplatin 60 mg/m2 every 3 weeks and PVI 5-FU 200 mg/m2/d) or MCF (mitomycin 7 mg/m2 every 6 weeks, cisplatin 60 mg/m2 every 3 weeks, and PVI 5-FU 300 mg/m2/d) and analyzed for survival, response, toxicity, and quality of life (QOL). RESULTS: The overall response rate was 42.4% (95% confidence interval [CI], 37% to 48%) with ECF and 44.1% (95% CI, 38% to 50%) with MCF (P = .692). Toxicity was tolerable, and there were only two toxic deaths. ECF resulted in more grade 3/4 neutropenia and grade 2 alopecia, but MCF caused more thrombocytopenia and plantar-palmar erythema. Median survival was 9.4 months with ECF and 8.7 months with MCF (P = .315); at 1 year, 40.2% (95% CI, 34% to 46%) of ECF and 32.7% (95% CI, 27% to 38%) of MCF patients were alive. Median failure-free survival was 7 months with both regimens. Global QOL scores were better with ECF at 3 and 6 months. CONCLUSION: This study confirms response, survival, and QOL benefits of ECF observed in a previous randomized study. The equivalent efficacy of MCF was demonstrated, but QOL was superior with ECF. ECF remains one of the reference treatments for advanced esophagogastric cancer.

Comparison of two high doses of subcutaneous buprenorphine in cats undergoing ovariohysterectomy

2019 ◽  
Vol 24 (10) ◽  
pp. 504-514
Author(s):  
Rosa Leedham ◽  
Kate L White ◽  
David Yates ◽  
Lauren Brown
Keyword(s):  
Clinical Study ◽  
Acute Pain ◽  
Pain Scale ◽  
Rescue Analgesia ◽  
Physiological Variables ◽  
Blinded Observer ◽  
High Doses ◽  
Induction Of Anaesthesia ◽  
To Receive

Objectives: The aim of the study was to evaluate the analgesia and recovery effects of two doses (0.12 mg/kg and 0.24 mg/kg) of subcutaneous buprenorphine in cats undergoing ovariohysterectomy. Methods: This was an assessor-blinded, randomised, clinical study. A total of 83 cats were recruited and randomly allocated to receive 0.12 mg/kg buprenorphine or 0.24 mg/kg buprenorphine subcutaneously, followed 30 minutes later by 40 μg/kg medetomidine intramuscularly. Anaesthesia was induced with intravenous alfaxalone to effect and maintained with isoflurane in oxygen. All cats received meloxicam before surgery. Temperament score, quality of sedation, induction of anaesthesia, dose of alfaxalone and recovery were scored using simple descriptive scales. Atipamazole was administered following surgery. Physiological variables during anaesthesia were recorded. Cats were assessed postoperatively by the same blinded observer at 2, 4 and 24 hours using a modified Colorado Feline Acute Pain scale. The presence or absence of mydriasis was noted. Results: No significant differences were identified between groups. Three cats in the 0.12 mg/kg group and four in the 0.24 mg/kg group required rescue analgesia. Mydriasis persisting for at least 24 hours was evident in 75 cats. Conclusions and relevance: No differences in analgesia were detected between groups with these protocols; mydriasis was common in both groups.

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

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