Maternal and Child Health Commons^™

Formative Research On Assessing Barriers To Fistula Care And Treatment In Nigeria, Charlotte E. Warren, Rachel Agbonkhese, Salisu Mohammed Ishaku

Reproductive Health

This report documents results of a systematic study of peer-reviewed and “grey” literature which identified studies relevant for understanding barriers to accessing obstetric fistula (OF) care in developing countries. To more comprehensively and holistically understand these barriers in Nigeria and potential enabling factors for alleviation, this study explored the perspectives of those involved in both identifying fistula and accessing care, such as family members and other community stakeholders including patriarchs, matriarchs, community leaders, and other opinion leaders. It also examines the cultural patterns, myths, and perspectives related to OF and how they influence women’s willingness and capacities to access surgical …

Barriers To Fistula Repair In Uganda: A Formative Study, Population Council

Reproductive Health

This brief describes a formative research study conducted in Uganda by the Population Council, building on the results of a systematic review, to better understand the barriers and enabling factors for fistula repair care delivery and access. Understanding how Ugandan women living with fistula decide to seek care, identify and reach medical centers, and receive adequate and appropriate care is integral and continues to influence the design of a larger implementation pilot. This study focuses on Fistula Care Plus project-supported treatment facilities where fistula camps are routinely held. Results show that while it is difficult to measure the relative influence …

Fact Sheet—How Does Quality Of Care Relate To A Rights-Based Approach To Family Planning Programs?, Jan Kumar

Reproductive Health

Because policymakers are challenged by numerous, overlapping definitions of quality of care, with uncertainty about which to adopt, there is a need for common understanding of each construct and its contribution to family planning (FP). This factsheet describes several definitions of quality in health care that are widely accepted. It concludes that improving and assuring quality of care is a legal, ethical, and practical imperative, and is instrumental in achieving outcomes that benefit women, children, and programs. If donors embrace, fund, and hold governments accountable to the fullness of a rights-based approach for FP with an explicit focus on assuring …

Measuring Quality Of Care: A Review Of Previously Used Methodologies And Indicators, Katherine Tumlinson

Reproductive Health

Despite successful efforts to increase financial and geographic access to family planning services in many parts of the developing world, large numbers of women with a desire to delay or limit future pregnancies are not using contraceptive methods. Several multi-country, large-scale facility surveys incorporate indicators for measuring the quality of family planning service delivery. These facility surveys use data collection tools such as facility audits, provider and client questionnaires, and third party observation guides. A limited body of research indicates that the validity of these tools is low, however, while large variations in analytical approaches inhibit use of existing literature …

Fact Sheet—Measuring Quality Of Care: A Review Of Methodologies And Indicators, Katherine Tumlinson

Reproductive Health

Broad support for the promotion of high-quality service delivery in family planning (FP) programs is rooted in the publication in 1990 of a formal framework outlining its essential elements. This framework, developed by Judith Bruce of the Population Council, defines FP service delivery quality through six critical elements: choice of methods, information provided to clients, interpersonal relations, provider competence, follow-up mechanisms, and appropriate range of services offered. This factsheet argues that despite widespread endorsement of the Bruce framework and development of standardized data collection instruments, obstacles to accurate measures of quality of care remain. It concludes that further discussion within …

Evaluation De La Mise En Oeuvre Et Des Réalisations De L’Approche 3d Au Sein Du Plan D’Action National De Planification Familiale (Panpf) Au Sénégal—Technical Brief, Population Council

Reproductive Health

Leader dans le domaine de la Planification Familiale (PF) en Afrique de l’Ouest francophone, le Sénégal a entrepris diverses initiatives pour atteindre ses objectifs, dont l’élaboration du Plan d’Action National de Planification Familiale (PANPF) 2012–15, basé sur l’Approche 3D (Démocratisation, Démédicalisation, Décentralisation). Au moment où il arrivait à terme, et que l’élaboration d’un nouveau plan était envisagée, il était nécessaire de documenter l’approche, sa mise en œuvre, et ses réalisations. Le Population Council a mené cette étude en collaboration avec la Direction de la Santé de la Reproduction et de la Survie de l’Enfant du Ministère de la Santé et …

A Model For Providing 24-Hour Normal Delivery Services At Union Health And Family Welfare Centers In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, A.K.M. Zafar Ullah Khan, Forhana Rahman Noor, Afsana Fatema Noor

Reproductive Health

In rural areas of Bangladesh, emergency obstetric care services are available at the upazila level and above. At lower levels, Union Health and Family Welfare Centers (UHFWCs) located in the proximity of women’s homes provide normal delivery services. Recently, the Directorate General of Family Planning (DGFP) undertook an initiative to provide 24-hour normal delivery services in newly upgraded UHFWCs. The Population Council, with financial support from UKaid is providing technical assistance to the DGFP to implement an operations research study to test the effectiveness of this model. This brief presents an overview of the project, describes the implementation of project …

Evaluation Of The Impact Of Strengthening Union Health And Family Welfare Centers For Providing 24/7 Normal Delivery Services In Bangladesh, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan, Mohammed Sharif, Forhana Rahman Noor, Surojit Kundu, Shongkour Roy, Afsana Fatema Noor, Ubaidur Rob

Reproductive Health

In Bangladesh, the majority of the infant deliveries in rural areas take place at homes where there is a higher risk of morbidity and mortality. Most Union Health and Family Welfare Centers (UHFWCs) are unable to provide 24-hour normal delivery services in close proximity to most rural women. With this point of view, the Population Council has provided technical assistance to the Directorate General of Family Planning to implement an operations research (OR) study in 24 UHFWCs to test the effectiveness of a model to strengthen UHFWCs so that they can provide such services. This report presents the findings of, …

Using The Community Informant Based (Made-In And Made-For) Methodology For Estimating Maternal Mortality Ratio (Mmr) In Districts Haripur And Nowshera, Khyber Pakhtunkhwa, Population Council

Reproductive Health

Through its Reproductive Maternal and Neonatal Child Health project, GIZ Pakistan is assisting the Government of Pakistan in strengthening its health system’s capacities for ensuring effective, efficient, client-oriented, and affordable reproductive, maternal, newborn, and adolescent health care. GIZ engaged with senior national and provincial government officials who indicated their interest in applying the innovative Made-In/Made-For (Maternal Death, from Informants/Maternal Death, Follow On Review) methodology, a cost-effective alternative for generating reliable estimates of maternal mortality through community-based informant networks. This Population Council study in two pilot districts identified specific areas that need strong policy and programmatic interventions to improve maternal health …

Using The Community Informant-Based (Made-In And Made-For) Methodology To Estimate The Neonatal Mortality Rate (Nmr) In Nowshera, Khyber Pakhtunkhwa: A Feasibility Study, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood, Mansoor Qaisar, Sabahat Hussain, Rehan M. Niazi

Reproductive Health

Concerned about high levels of neonatal mortality, the Khyber Pakhtunkhwa district government in Pakistan expressed a need to adapt and test a new approach—commonly referred to as the “Made-In/Made-For” (MIMF) method—that uses community-based informants to estimate the number of maternal deaths. The current pilot study in Nowshera was commissioned by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH and conducted by the Population Council to test the feasibility of using the method, and community-based informant networks that had been used to measure maternal mortality, for estimating neonatal deaths. This study clearly shows that, in addition to identifying maternal deaths, informant …

Using The Community Informant Based (Made-In And Made-For) Methodology For Estimating Maternal Mortality Ratio (Mmr) In Khyber Pakhtunkhwa, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood

Reproductive Health

This report documents a study by the Population Council estimating the maternal mortality ratio of Khyber Pakhtunkhwa (KP) province in Pakistan using an innovative community informant–based method, known as the “Made-In/Made-For” (MIMF) technique, to collect data on maternal deaths. The report confirms that maternal mortality persists as a major public health issue in KP, and the problem may be much larger than assumed. The study’s success in identifying causes of death through verbal autopsies and their subsequent disaggregation into direct and indirect causes is important from policy and programmatic perspectives. Interventions need to focus both on direct and indirect causes …

El Rol De Los Servicios Sociales En El Acompañamiento De Mujeres Durante El Proceso De Interrupción Legal Del Embarazo En Un Hospital Público En La Provincia De Buenos Aires / The Role Of Social Services In The Accompaniment Of Women During The Process Of Legally Terminating A Pregnancy In A Public Hospital In The Province Of Buenos Aires, Judy Rivière

Independent Study Project (ISP) Collection

El acceso a la Interrupción Legal del Embarazo (ILE) sigue siendo limitado para muchas mujeres en Argentina. En la mayoría de los hospitales públicos, no se hace la ILE. Este tema es todavía muy polémico y tiene implicaciones diferentes, no solo en el nivel provincial, sino también en el nivel municipal. En las instituciones donde se hacen interrupciones del embarazo, los profesionales de la salud tienen mirada abierta que incluyen factores biopsicosociales. Por eso, las trabajadoras sociales, que miran la salud desde la perspectiva de determinantes sociales, tienen un rol importante en la facilitación del acceso a la ILE para …

Is There A Trade-Off? Infant Health Outcomes And Managed Care Competition, Shana L. Moore

Theses and Dissertations--Public Policy and Administration

This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to …

Enteric Fever: A Slow Response To An Old Plague, Carlos Franco- Paredes, M. Imran Khan, Esteban Gonzalez- Diaz, Jose I. Santos- Preciado, Alfonso J. Rodriguez Morales, Eduardo Gotuzzo

Centre of Excellence in Women and Child Health

Man is irremediably embedded in nature with complex interactions with all living organisms. Historically, the establishment of contemporary human societies has been influenced by our coexistence with other microorganisms living in highly interconnected habitats and ecologies. As a result, with the progression from unicellular to multicellular life, bacteria have coexisted with humans. In this biological journey, while there are important benefits provided by bacterial guests to the human host living in complex relationships and becoming part of their microbiome, some organisms are able to cause a wide spectrum of diseases. Among the large Enterobacteriaceae family, the genus Salmonella, a …

Status Of Paratyphoid Fever Vaccine Research And Development, Laura B. Martin, Raphael Simon, Calman A. Maclennan, Sharon M. Tennant, Sushant Sahastrabuddhe, M. Imran Khan

Centre of Excellence in Women and Child Health

Salmonella enterica serovars Typhi and Paratyphi (S. Paratyphi) A and B cause enteric fever in humans. Of the paratyphoid group, S. Paratyphi A is the most common serovar. In 2000, there were an estimated 5.4 million cases of S. Paratyphi A worldwide. More recently paratyphoid fever has accounted for an increasing fraction of all cases of enteric fever. Although vaccines for typhoid fever have been developed and in use for decades, vaccines for paratyphoid fever have not yet been licensed. Several S. Paratyphi A vaccines, however, are in development and based on either whole cell …

Nontyphoidal Salmonella Disease: Current Status Of Vaccine Research And Development, Sharon M. Tennant, Calman A. Maclennan, Raphael Simon, Laura B. Martin, M. Imran Khan

Centre of Excellence in Women and Child Health

Among more than 2500 nontyphoidal Salmonella enterica (NTS) serovars, S. enterica serovar Typhimurium and S. enterica serovar Enteritidis account for approximately fifty percent of all human isolates of NTS reported globally. The global incidence of NTS gastroenteritis in 2010 was estimated to be 93 million cases, approximately 80 million of which were contracted via food-borne transmission. It is estimated that 155,000 deaths resulted from NTS in 2010. NTS also causes severe, extra-intestinal, invasive bacteremia, referred to as invasive nontyphoidal Salmonella (iNTS) disease. iNTS disease usually presents as a febrile illness, frequently without gastrointestinal symptoms, in both adults and children. Symptoms …

An Evaluation Of The Screening And Management Of Childhood Overweight And Obesity In The Primary Care Setting, Diane L. Crutcher

DNP Projects

Background: Worldwide, the World Health Organization (2016) estimates that forty-two million children from two to five years of age are overweight or obese. In the United States, Kentucky ranks sixth for the highest rate of overweight youth in the nation (Partnership for Fit Kentucky, 2009). The long term consequences of overweight and obesity are early onset of adult chronic diseases as well as social and psychological issues in childhood and adulthood.

Purpose: The objective of this gap analysis was to assess BMI screening and weight management of children ages two to five who presented for a well-child check …

Nutritional Status And Tuberculosis Risk In Adult And Pediatric Household Contacts, Omowunmi Aibana, Xeno Acharya, Chuan-Chin Huang, Mercedes C Becerra, Jerome T Galea, Silvia S Chiang, Carmen Contreras, Roger Calderon, Rosa Yataco, Gustavo E Velásquez, Karen Tintaya, Judith Jimenez, Leonid Lecca, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Studies show obesity decreases risk of tuberculosis (TB) disease. There is limited evidence on whether high body mass index also protects against TB infection; how very high body mass indices influence TB risk; or whether nutritional status predicts this risk in children. We assessed the impact of body mass index on incident TB infection and disease among adults and children.

METHODS AND FINDINGS: We conducted a prospective cohort study among household contacts of pulmonary TB cases in Lima, Peru. We determined body mass index at baseline and followed participants for one year for TB infection and disease. We used …

Frequency Of Retinopathy Of Prematurity In A Tertiary Care Hospital, Shiyam Sunder Tikmani, Tufail Soomro, Prashant Tikmani

Community Health Sciences

Introduction: Retinopathy of prematurity (ROP) is one of a preventable cause of blindness in neonates. Screening of preterm infants for ROP in Pakistan is currently under-recognized. The aim of this study was to determine the frequency of retinopathy of prematurity (ROP) in premature and very low birth weight neonates (birth weight ≤ 1500 g and gestational age ≤ 32 weeks) in a tertiary care hospital, Karachi, Pakistan.
Methods: This was a cross-sectional study carried out in the neonatal intensive care unit (NICU) of Civil Hospital Sukkur from 1st June 2014 to 17th June 2015. Preterm neonates with birth weight ≤ …

Social Determinants Of Maternal And Child Undernutrition In Cambodia: A Systematic Review, Pheak Chhoun, Khuondyla Pal, Sreymom Oy, Candice Collins, Sovannary Tuot, Siyan Yi

Background: Maternal and child undernutrition is one of the major contributors to the increasing of overall disease burden and mortality in the globe and Cambodia. Therefore, a systematic literature review was conducted to identify social determinants of maternal and child undernutrition in Cambodia.

Methods: Systematic literature search was performed through journal databases including ProQuest Central, Scopus, PubMed, Medline (Ovid), Google scholar, and World Health Organization Statistical Information System (WHOSIS). Keywords were used to search for literature in English published from 2003 to 2015. Content analysis was conducted among final selected papers.

Results: In total, 25 articles met …