Digital Commons Network^™

Reciprocal Effects Of Health And Economic Well-Being Among Older Adults In Taiwan And Beijing, Kristine R. Baker, Mary Beth Ofstedal, Zachary Zimmer, Zhe Tang, Yi-Li Chuang

Poverty, Gender, and Youth

The objectives of this Population Council study are threefold: 1) to examine whether socioeconomic status disparities in health are found in non-Western settings; 2) to assess whether socioeconomic status gradients in health endure into older ages; and 3) to evaluate the direction of causality between health and socioeconomic status. Findings provide evidence for reciprocal effects of economic well-being and health among older adults in both Taiwan and Beijing. Those with higher levels of economic well-being have lower levels of functional limitation over time, and those with higher levels of functional limitation have lower levels of economic well-being over time. Consistent …

The Impact Of Childhood Mortality On Fertility In Six Rural Thanas Of Bangladesh, Mian Bazle Hossain, James F. Phillips, Thomas K. Legrand

Poverty, Gender, and Youth

This Population Council working paper examines the causal structure of the relationship between child mortality events and subsequent fertility during a time of rapid decline in fertility in Bangladesh. Results lend support to the hypothesis of an insurance effect, while demonstrating that its demographic significance is likely to be less prominent than that of replacement behavior. Findings indicate that the insurance motive remains intact even after total fertility declined to fewer than three children per woman. The well-documented role of gender bias as a determinant of child health and survival is also a factor in child-replacement decisionmaking. Although the rapid …

The Changing Context Of Sexual Initiation In Sub-Saharan Africa, Barbara Mensch, Monica J. Grant, Ann K. Blanc

Poverty, Gender, and Youth

This working paper investigates the links between changing age at marriage and premarital sexual behavior in 27 sub-Saharan African countries in which Demographic and Health Surveys were conducted between 1994 and 2003. Using multiple-decrement life tables to examine the competing risks of premarital sex and marriage without prior sexual experience, we answer the largely unaddressed question of how reductions in the prevalence of early marriage have affected the likelihood of initiating premarital sex. Our analysis reveals that although the age of first sexual activity has either remained the same or increased, a shift in the context of sexual debut from …

Kutibu Majeraha, Kutia Matumaini: Ushirikiano Wa Watanzania Dhidi Ya Fistula Obstetrikia, Thoraya Ahmed Obaid, Erica Chong

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité describes a partnership formed to combat obstetric fistula in Tanzania. The Bugando Medical Center, the Women’s Dignity Project, the Tanzania Midwives Association, and the government cooperated on an extensive program for surgical repair, prevention, and policy research and activities. Lessons learned: 1) Fistula programs need to address social as well as medical issues. 2) Most repairs are successful, making an enormous difference in women’s lives. 3) Relatively little funding is necessary to start up a fistula program. 4) Fistula programs are vehicles for broader conversations about gender and poverty.

How Many Years Of Life Could Be Saved If Malaria Were Eliminated From A Hyperendemic Area Of Northern Ghana?, Ayaga A. Bawah, Fred N. Binka

Poverty, Gender, and Youth

For some time, Chinese government policies have treated rural and urban areas very differently, and a by-product of China’s rapid development seems to be an even greater differentiation between urban and rural social and economic life. Over the next several decades, in part because of rapid fertility declines and in part as a result of mortality declines at older ages, China and other developing countries will experience enormous increases in the proportion of older adults and the proportion of the “oldest-old.” It is reasonable to expect that these age structure changes will alter the provision of health care, making an …

Transferring Ghana's System Of Evidence-Based Health Program Development: Program For An Initial Exchange With Sierra Leone And Burkina Faso, Frontiers In Reproductive Health

Reproductive Health

Ghana’s Community-based Health Planning and Services (CHPS) experiment demonstrated that mobilizing community volunteerism, in combination with retraining and redeploying nurses to village-based locations reduced childhood mortality rates in that country. Thus, CHPS has become the government’s primary strategy for realizing universal access to health care. This report provides a description of an initial exchange organized by the Ghana Health Service, the Navrongo Health Research Centre, and the Population Council to explore ways of transferring and adapting these evidence-based strategies to other countries in the region. The exchange included representatives from the Sierra Leone Ministry of Health and Sanitation and the …

Cross-Cultural Adaptation Of Reproductive Health Services In Bolivia, Fernando Gonzales Salguero, Antonieta Martin, Rosario Perez Mendoza, Ricardo Vernon

Reproductive Health

The Bolivian Ministry of Health and Sports and the Integral Health Project, with the technical assistance of the Population Council’s Frontiers in Reproductive Health Program (FRONTIERS), tested several strategies to make health services in Bolivia more culturally appropriate for the country’s indigenous peoples. The goal of the project was to increase women’s access to, use of, and satisfaction with health services in general, and reproductive health services in particular, through: a) enhanced understanding and acceptance of the “other” culture; b) improving communication skills; c) facilitating and promoting use of the Quechua language in clinics; d) systematically screening clients’ health service …

Operations Research To Improve Postabortion (Pac) Services In Three Public Hospitals, Bolivia, Fernando Gonzales Salguero, Mariel Loayza

Reproductive Health

In the last five years, Pathfinder Bolivia has provided technical assistance, training and equipment to the Ministry of Health (MOH) to implement postabortion care (PAC) services in eight hospitals. They invited Frontiers in Reproductive Health (FRONTIERS) to provide the technical assistance and training for conducting operations research (OR) activities. This report describes the second stage of this collaborative effort as presented in a three-day workshop attended by providers and staff members of the participant hospitals. During the workshop, participants received OR training and developed draft OR proposals seeking to improve PAC service delivery problems identified during the first study. The …

Use Of Systematic Screening To Increase The Provision Of Reproductive Health Services In Bolivia, James R. Foreit, Ricardo Vernon, Patricia Riveros Hamel

Reproductive Health

The objective of this study was to determine if the use of a checklist to screen for unmet service needs could increase the number of services per visit provided to clients using rural Bolivian health facilities. Measurement included changes in services per visit before and after the introduction of the intervention, and a comparison of services received at screened and non-screened visits. Findings show that, to the degree that provider compliance can be secured, systematic screening of clients appears to be an effective method for reducing unmet health service needs. The findings of this study replicate those of other studies …

Willingness-To-Pay For Services Provided By The Clinical Services Improvement Project (Csi) In Egypt, John H. Bratt, Nahla G. Abdel-Tawab, Magdi A. Ibrahim, Mohammed Edress

Reproductive Health

Willingness-to-pay (WTP) surveys are increasingly used in reproductive health programs to predict the impact of price changes on revenues, utilization, and client profile. The FRONTIERS program worked with the Clinical Services Improvement (CSI) project and the Cairo Demographic Center to carry out a WTP survey in six CSI clinics in Egypt. The survey found that most clients would be willing to pay higher prices for CSI services, and WTP did not vary much by client economic status. However, predictive validity was low when all reasons for client discontinuation were included. WTP surveys have the potential to be useful tools for …

An Assessment Of Trends In The Use Of The Iud In Ghana: National Results Dissemination And Utilization, Ivy Osei, John Gyapong, Monica Wanjiru, Ian Askew

Reproductive Health

The overall aim of this study was to inform the Ghana Health Service, USAID, and other partners involved in providing family planning services in Ghana about future directions that could be taken to reinvigorate the IUD within the context of a family planning service based on the principles of free and informed choice. The Health Research Unit conducted the study, with technical assistance from FRONTIERS and funding from USAID. The findings showed that the declining interest in and use of the IUD as a family planning method could be attributed to several factors, including negative perceptions and false beliefs about …

Improving The Ghanaian Safe Motherhood Programme, Ivy Osei, Bertha Garshong, Gertrude Banahene, John Gyapong, Placide Tapsoba, Ian Askew, Clement Ahiadeke, Richard Killian, Edward Bonku, Perle Combary, William Sampson

Reproductive Health

Prior to the Ghana Ministry of Health scaling up the country’s Safe Motherhood program, they requested support from the Population Council’s USAID-funded Frontiers in Reproductive Health program to undertake an operations research study to evaluate and compare the cost-effectiveness of two training approaches and other performance improvement interventions. The study measured and compared changes in provider knowledge and skills and the costs of implementing a three-week residential vs. self-paced learning (SPL) approach. The SPL approach costs more per trainer than the traditional residential approach, both in financial costs alone and when opportunity costs are added, however, a cost-effectiveness analysis showed …

Improving Access To Long-Term Contraceptives In Rural Guatemala Through The Ministry Of Health, Edwin Montufar, Carlos Morales, Ricardo Vernon, Carlos Brambila, Jorge Solorzano

Reproductive Health

The purpose of this study was to test a model to train nurse auxiliaries at health centers and posts in Guatemala and to determine whether these providers could deliver adequate, cost-effective services. The training model consisted of: a) selection of nurse auxiliaries; b) two-day group training; c) on-the-job training, including work with actual clients at the trainees’ work centers; and d) certification of trainees who had conducted at least five quality insertions under supervision. This study has shown that nonprofessional health providers can effectively provide quality IUD services in Guatemala. The main recommendation derived from the project is to scale …

Expanding Access To Vasectomy Services In The Ministry Of Health Of Guatemala, Blanca De Rodriguez, Ricardo Vernon, Jorge Solorzano

Reproductive Health

This project tested the effectiveness of a systemic model for introducing vasectomy in service delivery units of the Guatemalan Ministry of Health (MOH), which has four basic components: a) the self-selection of health units according to their response to an invitation to participate in the project; b) the development of a counseling and information model for potential clients; c) training and sensitizing of health teams; and d) on-site training of surgeons. The report concludes that the introduction model for vasectomy in the MOH centers was successful. A high proportion of hospitals that identified vasectomy candidates finished the process, and the …

Systematic Screening As A Strategy To Increase Services Integration And Revenues In Honduras, Ricardo Vernon, James R. Foreit, Fiorella Mancini, Suyapa Pavon, Jheisy Torres

Reproductive Health

This operations research study, undertaken by the Honduras Family Planning Association (Asociación Hondureña de Planificación de Familia—ASHONPLAFA), tested the effectiveness of systematic screening to increase the number of services and revenue per visit in a reproductive health program. Despite monitoring plans, provider compliance with the intervention was low; the overall proportion of clients screened was less than 11 percent, and the frequency of screening varied greatly by clinic contact point. Although the study did not show an increase in the mean number of services per client, the negative results could reasonably be attributed to lack of implementation of the intervention. …

Systematic Screening To Integrate Reproductive Health Services In India, N.P. Das, Urvi Shah, Varsha Chitania, Pratibha Patel, M.E. Khan, Anurag Mishra, James R. Foreit

Reproductive Health

This study, conducted in large public clinics and small health posts in the city of Vadodara, India, tested the effectiveness of a systematic screening technique in integrating reproductive health services at the provider level. The objective was to determine if women screened during clinic visits received more services, appointments, and referrals per visit than women who were not screened. Results show that in experimental group clinics the number of services per visit increased while control clinics experienced a slight decrease; the effect of systematic screening was smaller in health posts than in clinics. In experimental posts, services per visit increased …

Nursing Staff Dynamics And Implications For Maternal Health Provision In Public Health Facilities In The Context Of Hiv/Aids, Loveday Penn-Kekana, Duane Blaauw, Khin San Tint, Desiree Monareng, Jane Chege

Reproductive Health

This study, carried out in Limpopo, KwaZulu-Natal, and Mpumalanga provinces in South Africa, aimed to document nursing staff dynamics in maternal health services, and to explore the factors associated with these dynamics. The study found that a high percentage of nursing staff working in public facilities were demotivated, burnt out, and were considering leaving the facility where they were working. A range of factors, both financial and nonfinancial, were associated with nurses considering going overseas: inadequate pay, poor promotion, feeling unsupported by management, and having bad relationships at work were all associated with lack of organizational commitment. As a result …

Feasibility Of Introducing A Comprehensive Package Of Antenatal Care Services In Rural Public Clinics In South Africa, Jane Chege, Ian Askew, Nzwakie Mosery, Mbali Ndube-Nxumalo, Busi Kunene, Mags Beksinska, Janet Dalton, Ester Snyman, Wilem Sturm, Preshny Moodley

Reproductive Health

The Maternal, Child and Women’s Health Unit, in collaboration with the Population Council’s FRONTIERS in Reproductive Health (FRONTIERS) program, the Reproductive Health Research Unit of the University of Witwatersrand, and the Department of Medical Microbiology and Infectious Diseases of the Nelson Mandela School of Medicine, University of Natal, developed and then pilot-tested this revised model in KwaZulu-Natal, South Africa. The project’s objective was to develop and test an improved and integrated antenatal care program for public-sector clinics that would increase the range and quality of services received by pregnant women and improve their reproductive health behavior and status. Various problems, …

Using Systematic Screening To Increase Integration Of Reproductive Health Services Delivery In Senegal, Diouratie Sanogo, Ricardo Vernon, James R. Foreit, Awa M. Coll-Seck, Colonel Adama Adoye, Laty G. Ndoye, Cheikh Bamba Diop, Balla Mbacke Mboup, Omar Sarr

Reproductive Health

This study tested the systematic screening technique to increase the integration of reproductive health services in Senegal. The study took place in four urban health posts in the city of Dakar and three rural health posts in the district of Kebemer. A before and after design tested the hypothesis that the use of the systematic screening tool would result in more services received per client visit. In Dakar, services per visit increased significantly by 20 percent, while in Kebemer, services per visit also increased significantly by 35 percent. The study also examined several techniques to improve provider compliance with the …

Blood Lead And Decision Speed In Working Age Adults, S. W. Harkins

Theses and Dissertations

Lead is a central nervous system poison. Healthy People 2010 established a target blood lead level (BLL) for children of 0 μg/dL by 2010, but is silent with regard to any changes in BLLs standards for working age adults. In this paper, the relation of BLL to performance on two neurobehavioral tests was assessed in working age adults (N = 4909; Age 20 to 59 years; 51.4% Female) employing data from the Third National Health and Nutrition Survey (NHANES 111). Multiple linear regression analyses indicated a significant effect of BLL on time taken to complete an attention demanding cognitive task …

Predictors Of Sun Protection Practices Among Adult Women In The United States, Anne Ridgely Minter

Theses and Dissertations

Background. Skin cancer is the most common form of cancer in the United States. The main modifiable risk factor for skin cancer is exposure to excessive sun and UV radiation. More than 90% of all skin cancers are known to be caused by sun exposure. However, studies on excessive sun and UV exposure are limited. The purpose of this study was to examine risk and protective factors affecting sun protection behaviors of adult women in the United States. Methods. Data on U.S. adult women (n=17,425) from the 2003 National Health Information Survey (NHIS) was analyzed. Sun protection behaviors were assessed …

Predictors Of Early Onset Of Sexual Intercourse In Male And Female Residents Of The United States, Brianna Michele Magnusson

Theses and Dissertations

Abstract Purpose: The United States has the highest rate of teen pregnancy of any industrialized nation. Adolescents who have their first sexual intercourse at a young age are at increased risk for teen pregnancies and acquiring a sexually transmitted disease. This study examines predictors of early onset sexual intercourse in male and female residents of the United States. Methods: A nationally representative sample of N=7,643 females and N=4.928 males ages 15-44 was procured from the 2002 National Survey of Family Growth (NSFG), Cycle 6. Age at first sexual intercourse was used to define early onset of sexual debut(<18 years). Socio-demographic and behavioral characteristics of the respondents, demographic and selected reproductive characteristics of the respondent's parents were examined using multiple logistic regression modeling. Results: Non-fispanic black, being raised without both parents, having a mother less than 18 years old at the age of first birth and age difference between partners were significant predictors of early onset of sexual intercourse for both males and females. Maternal education less than high school was a significant protective factor for female respondents [OR=0.72 (95%CI=0.58- 0.90)] and paternal education completed high school only [OR=1.4 (95% CI=l. 1-1.7)] was a significant risk factor for male respondents. Conclusions: Racelethnicity, age difference between partners, not being raised by both parents, having a mother who had her first birth before the age of 18 and parental education are important predictor variables. Further study should be conducted to investigate the protective effect of lack of maternal education for female respondents. Intervention programs for teen pregnancy and sexually transmitted infection prevention should target these at risk groups.

Effect Of Medicaid/Schip And Wic On Oral Health Of Low-Income Children, Dahlia Naqib

Theses and Dissertations

Oral caries is the most prevalent chronic disease among US children, and disproportionately impacts those of low socioeconomic status. Studies have shown that the Special Supplemental Nutrition Program for Women Infants and Children (WIC) improves access to dental care among Medicaid children. This study investigated the impact of WIC, Medicaid, and the State Children's Health Insurance Program (SCHIP) on the prevalence of dental caries among low-income children. The 1999-2000 and 2001-2002 NHANES data were utilized for this analysis. Children 2-4 years old who participated in WIC, Medicaid, or SCHIP, or who were uninsured, and for whom both interview and complete …

Analysis Of The Impact Of A Social Norms Campaign On The Alcohol Use Of Undergraduate Students At A Public, Urban University, Amanda B. Wattenmaker

Theses and Dissertations

Purpose: To conduct a secondary analysis of survey data collected at a large, urban university assessing for change in students' alcohol use perceptions and behaviors between 2002 and 2004. After the baseline data collection in 2002, the campus launched an intensive media intervention to normalize low-risk drinking. Simultaneously, the campus shifted from being a primarily commuter to primarily residential. Methods: This cross-sectional analysis used data collected from students in randomly selected undergraduate classes in February 2002 (n= 662) and 2004 (n=1334). The survey instrument used was the National College Health Assessment. Variables were categorized as demographic, alcohol perception, and alcohol …

Measurement Of Carbon Monoxide In Diesel Engine Exhaust, Michel Grenier

Rapports de recherche scientifique

Cliquez ici pour la version française de ce rapport

The measurement of carbon monoxide concentrations in the exhaust of diesel engines allows the identification of engines needing maintenance. Selecting the right instruments and the protocol to be followed is very important. The objectives of the work presented in this report are the selection and evaluation of the measuring instruments, as well as the selection of the protocol to be followed. The work related to the evaluation of the measuring instruments was carried out in the laboratory and underground, in order to identify the factors that could affect the measurement protocol. …

Importance De L’Organisation Du Travail Comme Soutien Aux Stratégies Protectrices Des Auxiliaires Familiales Et Sociales Afs Et Des Infirmières Des Services De Soins Et De Maintien À Domicile. Annexe 1 : Rapport De L'Étude Du Clsc 1, Esther Cloutier, Élise Ledoux, François Ouellet, Madeleine Bourdouxhe, Isabelle Gagnon, Hélène David, Catherine Teiger

Rapports de recherche scientifique

No abstract provided.

Étude Des Horaires De Travail Des Auxiliaires Familiales Et Sociales Des Services De Soins À Domicile Dans Un Clsc - Suivi D’Implantation Du Logiciel De Gestion Des Horaires. Annexe 5 : Rapport D’Intervention Du Clsc 1, Madeleine Bourdouxhe, Esther Cloutier, Élise Ledoux, Catherine Teiger, Hélène David, Isabelle Gagnon, François Ouellet

Rapports de recherche scientifique

Les contraintes de temps sont un élément de l’organisation du travail qui peut influencer les stratégies protectrices chez les auxiliaires familiales et sociales travaillant au maintien à domicile des patients de CLSC. Dans un des quatre CLSC participant à une recherche en cours, le milieu avait signalé un besoin spécifique concernant l’étude des horaires de travail et des heures supplémentaires chez les AFS. Les horaires de travail étaient donc un aspect organisationnel important dans ce CLSC en particulier, d’autant plus qu’on s’apprêtait à y implanter un logiciel de gestion des horaires qui se répand dans les établissements analogues, publics comme …

Importance De L’Organisation Du Travail Comme Soutien Aux Stratégies Protectrices Des Auxiliaires Familiales Et Sociales Et Des Infirmières Des Services De Soins Et De Maintien À Domicile. Annexe 3 : Rapport De L'Étude Du Clsc 3, Esther Cloutier, Isabelle Gagnon, Élise Ledoux, Madeleine Bourdouxhe, Hélène David, François Ouellet, Catherine Teiger

Rapports de recherche scientifique

No abstract provided.

Importance De L’Organisation Du Travail Comme Soutien Aux Stratégies Protectrices Des Auxiliaires Familiales Et Sociales Et Des Infirmières Des Services De Soins Et De Maintien À Domicile. Annexe 4 : Rapport De L’Étude Du Clsc 4, Élise Ledoux, Esther Cloutier, Hélène David, François Ouellet, Madeleine Bourdouxhe, Catherine Teiger, Isabelle Gagnon

Rapports de recherche scientifique

No abstract provided.

Importance De L’Organisation Du Travail Comme Soutien Aux Stratégies Protectrices Des Auxiliaires Familiales Et Sociales Et Des Infirmières Des Services De Soins Et De Maintien À Domicile. Annexe 2 : Rapport De L'Étude Du Clsc 2, Esther Cloutier, Élise Ledoux, Madeleine Bourdouxhe, Isabelle Gagnon, François Ouellet, Hélène David, Catherine Teiger

Rapports de recherche scientifique

No abstract provided.