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1.
Stud Fam Plann ; 51(1): 33-50, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32043621

RESUMO

Informal fees are payments made by patients to their health care provider that are over and above the official cost of services. Payments may be motivated by a combination of factors such as low supervision, weak sanctions, and inadequate provider salaries. The practice of soliciting informal fees from patients may result in restricted access to medical care and reduced care-seeking behavior among vulnerable populations. The objective of this study is to examine nuanced health care provider perspectives on informal fee payments solicited from reproductive health patients in Kenya. We conducted in-depth semistructured interviews in 2015-2016 among a sample of 20 public and private-sector Kenyan health care workers. Interviews were coded and analyzed using an iterative thematic approach. More than half of participants reported that solicitation of informal fees is common practice in health care facilities. Providers reported low public-sector wages were a primary driver of informal fee solicitation coupled with collusion among senior staff. Additionally, patients may be unaware that they are being asked to pay more than the official cost of services. Strategies for reducing this behavior include more adequate and timely remuneration within the public sector, educating patient populations of free or low-cost services, and evidence-based methods to increase provider motivation.

2.
BMC Health Serv Res ; 19(1): 660, 2019 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511004

RESUMO

BACKGROUND: Healthcare worker absenteeism is common in resource limited settings and contributes to poor quality of care in maternal and child health service delivery. There is a dearth of qualitative information on the scope, contributing factors, and impact of absenteeism in Kenyan healthcare facilities. METHODS: In-depth semi-structured interviews were conducted between July 2015 and June 2016 with 20 healthcare providers in public and private healthcare facilities in Central and Western Kenya. Interviews were audio-recorded, transcribed, coded, and analyzed using an iterative thematic approach. RESULTS: Half of providers reported that absenteeism occurs in both private and public health facilities. Absenteeism was most commonly characterized by providers arriving late or leaving early during scheduled work hours. The practice was attributed to institutional issues including: infrequent supervision, lack of professional consequences, limited accountability, and low wages. In some cases, healthcare workers were frequently absent because they held multiple positions at different health facilities. Provider absences result in increased patient wait times and may deter patients from seeking healthcare in the future. CONCLUSION: There is a significant need for policies and programs to reduce provider absenteeism in Kenya. Intervention approaches must be cognizant of the contributors to absenteeism which occur at the institutional level.


Assuntos
Absenteísmo , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Humanos , Quênia/epidemiologia , Admissão e Escalonamento de Pessoal , Pesquisa Qualitativa , Salários e Benefícios
3.
BMJ Glob Health ; 4(4): e001557, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406590

RESUMO

Objectives: Despite the recognised importance of adopting a continuum of care perspective in addressing the care of mothers and newborns, evidence on specific interventions to enhance engagement of women along the maternity care continuum has been limited. We use the example of the Accredited Social Health Activist (ASHA) programme in India, to understand the role of community health workers in retaining women in the maternity care continuum. Methods: Using the Indian Human Development Survey data from 2011 to 2012, we assess the association between individual and cluster-level exposure to ASHA and four key components along the continuum of care-at least one antenatal care (ANC) visit, four or more ANC visits, presence of a skilled birth attendance (SBA) at the time of birth and postnatal care for the mother or child within 48 hours of birth, for 13 705 women with a live birth since 2005. To understand which of these services experience maximum dropout along the continuum, we use a linear probability model to calculate the weighted percentages of using each service. We assess the association between exposure to ASHA and number of services utilised using a multinomial logistic regression model adjusted for a range of confounding variables and survey weights. Results: Our study indicates that exposure to the ASHA is associated with an increased probability of women receiving at least one ANC and SBA. In terms of numbers of services, exposure to ASHA accounts for a 12% (95% CI: 9.1 to 15.1) increase in women receiving at least some of the services, and an 8.8% (95% CI: -10.2 to -7.4) decrease in women receiving no services. However, exposure to ASHA does not increase the likelihood of women utilising all the services along the continuum. Conclusions: While ASHA is effective in supporting women to initiate and continue care along the continuum, it does not significantly affect the completion of all services along the continuum.

4.
Hum Resour Health ; 17(1): 68, 2019 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426801

RESUMO

BACKGROUND: In 2006, the Government of India launched the accredited social health activist (ASHA) program, with the goal to connect marginalized communities to the health care system. We assessed the effect of the ASHA program on the utilization of maternity services. METHODS: We used data from Indian Human Development Surveys done in 2004-2005 and in 2011-2012 to assess demographic and socioeconomic factors associated with the receipt of ASHA services, and used difference-in-difference analysis with cluster-level fixed effects to assess the effect of the program on the utilization of at least one antenatal care (ANC) visit, four or more ANC visits, skilled birth attendance (SBA), and giving birth at a health facility. RESULTS: Substantial variations in the receipt of ASHA services were reported with 66% of women in northeastern states, 30% in high-focus states, and 16% of women in other states. In areas where active ASHA activity was reported, the poorest women, and women belonging to scheduled castes and other backward castes, had the highest odds of receiving ASHA services. Exposure to ASHA services was associated with a 17% (95% CI 11.8-22.1) increase in ANC-1, 5% increase in four or more ANC visits (95% CI - 1.6-11.1), 26% increase in SBA (95% CI 20-31.1), and 28% increase (95% CI 22.4-32.8) in facility births. CONCLUSIONS: Our results suggest that the ASHA program is successfully connecting marginalized communities to maternity health services. Given the potential of the ASHA in impacting service utilization, we emphasize the need to strengthen strategies to recruit, train, incentivize, and retain ASHAs.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Adolescente , Adulto , Feminino , Programas Governamentais , Humanos , Índia , Estudos Longitudinais , Pessoa de Meia-Idade , Gravidez
5.
PLoS One ; 14(8): e0221688, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449542

RESUMO

BACKGROUND: Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent. Ukraine is one of 30 countries with the highest burden of multidrug-resistant tuberculosis. Global literature shows that social support (SS) is important in improving TB treatment adherence, reducing lost to follow up rates and improving treatment outcomes. There are several models of SS available, and the literature provides little information on what aspects of SS are most important to TB patients in improving their adherence. METHODS: We used qualitative data collected through in-depth interviews (IDI) with 21 TB patients and 15 SS providers and coordinators in Ukraine in August-September 2016 to understand how the SS program promoted treatment adherence among patients. We examined the aspects of outpatient TB treatment that made adherence particularly difficult for patients in at-risk groups and aspects of the SS programs that worked best for addressing those barriers. Interviews were transcribed and analysis was performed to derive emergent themes. RESULTS: Main barriers included side effects from medicine, the amount of time required daily for transportation and waiting in lines at the health facility, transportation expenses, risks of being identified when visiting a TB facility and lack of motivation to seek treatment. Features of the SS program most valued by patients were convenience of not having to visit facility and support provided by nurses. These two features directly addressed most of the barriers identified. The commitment and qualities of the nurses that provided the SS was an important element of the program. CONCLUSIONS: This qualitative study suggests that the SS program in Ukraine was successful in reducing treatment default among patients at high risk of default because it directly addressed most of the major barriers they faced to treatment adherence.


Assuntos
Apoio Social , Cooperação e Adesão ao Tratamento , Tuberculose/tratamento farmacológico , Feminino , Geografia , Humanos , Masculino , Ucrânia
6.
BMC Womens Health ; 18(1): 178, 2018 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373570

RESUMO

BACKGROUND: Evidence suggests that gender equality positively influences family planning. However, the evidence from urban Africa is sparse. This study aimed to examine the association between changes in gender norms and modern contraceptive use over time among women in urban Nigeria. METHODS: Data were collected in 2010/2011 from 16,118 women aged 15-49 living in six cities in Nigeria (Abuja, Benin, Ibadan, Ilorin, Kaduna, and Zaria) and again in 2014 from 10,672 of the same women (34% attrition rate). The analytical sample included 9933 women living in 480 neighborhoods. A four-category outcome variable measured their change in modern contraceptive use within the study period. The exposure variables measured the changes in the level of gender-equitable attitudes towards: a) wife beating; b) household decision-making; c) couples' family planning decisions; and d) family planning self-efficacy. Multilevel multinomial logistic regression models estimated the associations between the exposure variables at the individual and neighborhood levels and modern contraceptive use controlling for the women's age, education, marital status, religion, parity, household wealth, and city of residence. RESULTS: The proportion of women who reported current use of modern contraceptive methods increased from 21 to 32% during the four-year study period. At both surveys, 58% of the women did not report using modern contraceptives while 11% reported using modern contraceptives; 21% did not use in 2010/2011 but started using by 2014 while 10% used in 2010/2011 but discontinued use by 2014. A positive change in the gender-equitable attitudes towards household decision-making, couples' family planning decisions, and family planning self-efficacy at the individual and neighborhood levels were associated with increased relative probability of modern contraceptive use (adoption and continued use) and decreased relative probability of modern contraceptive discontinuation by 2014. No such associations were found between the individual and neighborhood attitudes towards wife beating and modern contraceptive use. Accounting for the individual and neighborhood gender-equitable attitudes and controlling for the women's demographic characteristics accounted for 55-61% of the variation between neighborhoods in the change in modern contraceptive use during the study period. CONCLUSION: Interventions that promote gender equality have the potential to increase modern contraceptive use in Nigerian cities.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Comportamento Contraceptivo/tendências , Anticoncepção/estatística & dados numéricos , Anticoncepção/tendências , Serviços de Planejamento Familiar/estatística & dados numéricos , Serviços de Planejamento Familiar/tendências , Normas Sociais , Adolescente , Adulto , Comportamento Contraceptivo/psicologia , Serviços de Planejamento Familiar/métodos , Feminino , Previsões , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nigéria , Gravidez , Adulto Jovem
7.
PLoS One ; 13(8): e0199513, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30092037

RESUMO

Ukraine is among the top 20 highest drug-resistant tuberculosis burden countries in the world. Driving the high drug-resistant tuberculosis rates is an unchecked treatment default rate. This evaluation measures the effect of social support provided to tuberculosis patients at risk of defaulting on treatment during outpatient treatment. Five tuberculosis patient cohorts, served in three oblasts from 2011 and 2012, were constructed from medical records to compare risk factors for default, receipt of social services, and treatment outcome. Regression analyses were used to identify risk factors predictive of treatment default and to estimate the impact of the social support program on treatment default, controlling for risk, disease status, and demographics. In 2012, tuberculosis patients receiving social support in Ukraine reduced their probability of defaulting on continuation treatment by 10 percentage points compared to high-risk patients who did not receive social support in 2012 or 2011. Treatment success rates for the high-risk patients receiving social support were comparable to the low-risk cohorts and significantly improved over the high-risk comparison cohorts. Further research is recommended to quantify the costs and benefits for scaling-up social support services, evaluate social support program fidelity, identify which populations respond best to select services, and what barriers might still exist to achieve better adherence. With that information, tailoring programs to most effectively reach and serve clients in a patient-centered approach may reap substantial rewards for Ukraine.


Assuntos
Apoio Social , Tuberculose/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Fatores de Risco , Serviço Social , Resultado do Tratamento , Tuberculose/epidemiologia , Ucrânia , Adulto Jovem
8.
South Med J ; 111(6): 317-323, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29863217

RESUMO

OBJECTIVES: Abortion clinics provide an ideal setting for women to receive contraceptive care because the women served may not have other contacts with the health system and are at risk for unintended pregnancies. The objective of this study was to understand practices, preferences, and barriers to use of contraception for women obtaining abortions at clinics in North Carolina. METHODS: We conducted a cross-sectional survey of abortion clients and facilities at 10 abortion clinics in North Carolina. We collected data on contraceptive availability at each clinic. We collected individual responses on women's experiences obtaining contraception before the current pregnancy and their intentions for future use of contraception. RESULTS: From October 2015 to February 2016, 376 client surveys were completed at 9 clinics, and 10 clinic surveys were completed. Almost one-third of women (29%) reported that they had wanted to use contraception in the last year but were unable. Approximately three-fourths of respondents (76%) stated that they intend to use contraception after this pregnancy. Approximately one-fifth of women stated that would like to use long-acting reversible contraception (LARC) after this abortion. Only the clinics that accepted insurance for abortion and other services provided LARC at the time of the abortion (40%). CONCLUSIONS: This study provides a unique, statewide view into the contraceptive barriers for women seeking abortion in North Carolina. Addressing the relatively high demand for LARC after abortion could help significantly reduce unintended pregnancy and recourse to abortion in North Carolina.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , North Carolina , Gravidez , Gravidez não Planejada/psicologia , Inquéritos e Questionários
9.
South Med J ; 110(11): 714-721, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29100222

RESUMO

OBJECTIVES: Abortion incidence has declined nationally during the last decade. In recent years, many states, including North Carolina, have passed legislation related to the provision of abortion services. Despite the changing political environment, there is no comprehensive analysis on past and current trends related to unintended pregnancy and abortion in North Carolina. METHODS: This study is a secondary analysis of vital registration data made publicly available by the North Carolina State Center for Health Statistics. Birth and induced abortion records were obtained for the years 1980 to 2013. We describe abortion incidence and demographic characteristics of women obtaining abortions over time. RESULTS: The number of North Carolina abortions declined 36% between 1980 and 2013. The abortion ratio declined from 26/100 pregnancies (live births and abortions) in 1980 to just 14/100 in 2013. These ratios, however, vary across demographic subgroups. In 2013, the abortion ratio was more than 2 times greater for non-Hispanic black women than non-Hispanic white women (22 and 9, respectively). Among non-Hispanic black and Hispanic women, the abortion ratio is greater among women with a previous pregnancy as compared with women in their first pregnancy. For non-Hispanic white women, the abortion ratios are similar for first and higher-order pregnancies. CONCLUSIONS: Trends in North Carolina are similar to national trends; however, detailed analyses by race/ethnicity, age, and parity demonstrate important distinctions among abortion patients over time in the state. We discuss these trends in relation to policy changes and increased access to effective contraceptives.


Assuntos
Aspirantes a Aborto/estatística & dados numéricos , Aborto Induzido/tendências , Grupos Étnicos/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Paridade , Aborto Induzido/legislação & jurisprudência , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Incidência , Nascimento Vivo , Pessoa de Meia-Idade , North Carolina , Gravidez , Taxa de Gravidez/tendências , Adulto Jovem
11.
SSM Popul Health ; 3: 525-533, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29349243

RESUMO

Bangladesh has made significant social, economic, and health progress in recent decades, yet many reproductive health indicators remain weak. Access to television (TV) is increasing rapidly and provides a potential mechanism for influencing health behavior. We present a conceptual framework for the influence of different types of TV exposure on individual's aspirations and health behavior through the mechanisms of observational learning and ideational change. We analyze data from two large national surveys conducted in 2010 and 2011 to examine the association between women's TV watching and five reproductive health behaviors controlling for the effects of observed confounders. We find that TV watchers are significantly more likely to desire fewer children, are more likely to use contraceptives, and are less likely to have a birth in the two years before the survey. They are more likely to seek at least four antenatal care visits and to utilize a skilled birth attendant. Consequently, continued increase in the reach of TV and associated growth in TV viewing is potentially an important driver of health behaviors in the country.

12.
Glob Health Sci Pract ; 4 Suppl 2: S122-39, 2016 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-27540119

RESUMO

BACKGROUND: Bangladesh has achieved a low total fertility rate of 2.3. Two-thirds of currently married women of reproductive age (CMWRA) want to limit fertility, and many women achieve their desired fertility before age 30. The incidence of unintended pregnancy and pregnancy termination is high, however. Long-acting reversible contraceptives (LARCs), consisting of the intrauterine device and implant, and permanent methods (PM), including female sterilization and vasectomy, offer several advantages in this situation, but only 8% of CMWRA or 13% of method users use these methods. PROGRAM: The Mayer Hashi (MH) program (2009-2013) aimed to improve access to and the quality of LARC/PM services in 21 of the 64 districts in Bangladesh. It was grounded in the SEED (supply-enabling environment-demand) Programming Model. Supply improvements addressed provider knowledge and skills, system strengthening, and logistics. Creating an enabling environment involved holding workshops with local and community leaders, including religious leaders, to encourage them to help promote demand for LARCs and PMs and overcome cultural barriers. Demand promotion encompassed training of providers in counseling, distribution of behavior change communication materials in the community and in facilities, and community mobilization. METHODS: We selected 6 MH program districts and 3 nonprogram districts to evaluate the program. We used a before-after and intervention-comparison design to measure the changes in key contraceptive behavior outcomes, and we used a difference-in-differences (DID) specification with comparison to the nonprogram districts to capture the impact of the program. In addition to the outcome evaluation, we considered intermediate indicators that measured the processes through which the interventions were expected to affect the use of LARCs and PMs. RESULTS: The use of LARCs/PMs among CMWRA increased between 2010 and 2013 in both program (from 5.3% to 7.5%) and nonprogram (from 5.0% to 8.9%) districts, but the rate of change was higher in the nonprogram districts. Client-provider interaction and exposure to LARCs/PMs were lower in the program than nonprogram districts, and the MH program districts had higher vacancies of key providers than the nonprogram areas, both indications of a more difficult health system environment. CONCLUSION: The weaknesses in the health system in the MH districts apparently undermined the effectiveness of the program. More attention to system weaknesses, such as additional supportive supervision for providers, might have improved the outcome.


Assuntos
Comportamento Contraceptivo , Implantes de Medicamento , Serviços de Planejamento Familiar/normas , Dispositivos Intrauterinos , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Esterilização Reprodutiva/estatística & dados numéricos , Adolescente , Adulto , Bangladesh , Anticoncepcionais Femininos , Feminino , Promoção da Saúde , Humanos , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Vasectomia/estatística & dados numéricos , Adulto Jovem
13.
Int J Equity Health ; 15: 27, 2016 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-26883742

RESUMO

BACKGROUND: Maternal healthcare utilization is a major determinant of maternal mortality. Bangladesh is experiencing a rapid pace of urbanization with all future growth in population expected to be in urban areas. Health care infrastructure is different in urban and rural areas thus warranting an examination of equity in use rates of maternal healthcare. This paper addresses whether the urban-rural and rich-poor gaps in use of selected maternal healthcare indicators have narrowed or widened over the last decade. The paper also explores changes in the service provider environment in urban and rural domains. METHODS: The 2001 and 2010 Bangladesh Maternal Mortality and Health Care Survey data were used to examine trends in use of antenatal care from medically trained providers and in deliveries taking place at health facilities. Separate wealth quintiles were constructed for urban and rural areas. The concentration index was calculated for urban and rural areas to measure equity in distribution of antenatal care (ANC) and facility deliveries across wealth quintiles in urban and rural domains. RESULTS: The gap in use of ANC provided by medically trained personnel narrowed in urban and rural areas between 2001 and 2010 while that in facility deliveries widened. The difference in use of ANC by the rich and the poor was not as pronounced as that in utilization of facilities for deliveries. Over the last decade, equity in utilization of health facilities for deliveries has improved at a faster rate in urban areas. Private sector has surpassed the public sector and appears to be the dominant provider of maternal healthcare in both domains with the share of NGOs increasing in urban areas. CONCLUSIONS: The faster pace of improvement in equity in maternal healthcare utilization in urban areas is reflective of the changing service environment in urban and rural areas, among other factors.


Assuntos
Equidade em Saúde/tendências , Serviços de Saúde Materna/tendências , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Bangladesh , Feminino , Equidade em Saúde/estatística & dados numéricos , Humanos , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos
14.
BMC Health Serv Res ; 15: 375, 2015 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-26369410

RESUMO

BACKGROUND: Performance-based financing (PBF) strategies are promoted as a supply-side, results-based financing mechanism to improve primary health care. This study estimated the effects of Rwanda's PBF program on less-incentivized child health services and examined the differential program impact by household poverty. METHODS: Districts were allocated to intervention and comparison for PBF implementation in Rwanda. Using Demographic Health Survey data from 2005 to 2007-08, a community-level panel dataset of 5781 children less than 5 years of age from intervention and comparison districts was created. The impacts of PBF on reported childhood illness, facility care-seeking, and treatment received were estimated using a difference-in-differences model with community fixed effects. An interaction term between poverty and the program was estimated to identify the differential effect of PBF among children from poorer families. RESULTS: There was no measurable difference in estimated probability of reporting illness with diarrhea, fever or acute respiratory infections between the intervention and comparison groups. Seeking care at a facility for these illnesses increased over time, however no differential effect by PBF was seen. The estimated effect of PBF on receipt of treatment for poor children is 45 percentage points higher (p = 0.047) compared to the non-poor children seeking care for diarrhea or fever. CONCLUSIONS: PBF, a supply-side incentive program, improved the quality of treatment received by poor children conditional on patients seeking care, but it did not impact the propensity to seek care. These findings provide additional evidence that PBF incentivizes the critical role staff play in assuring quality services, but does little to influence consumer demand for these services. Efforts to improve child health need to address both supply and demand, with additional attention to barriers due to poverty if equity in service use is a concern.


Assuntos
Serviços de Saúde da Criança/economia , Financiamento Governamental , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde/economia , Reembolso de Incentivo , Doença Aguda , Adulto , Criança , Pré-Escolar , Diarreia , Feminino , Febre , Inquéritos Epidemiológicos , Humanos , Masculino , Pobreza , Ruanda , Adulto Jovem
15.
Int Perspect Sex Reprod Health ; 41(2): 69-79, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26308259

RESUMO

CONTEXT: Family planning is highly beneficial to women's overall health, particularly in developing countries. Yet, in much of Sub-Saharan Africa, contraceptive prevalence remains low and unmet need for family planning remains high. It is hypothesized that the poor quality of family planning service provision in many low-income settings is a barrier to contraceptive use, but this hypothesis has not been rigorously tested. METHODS: Survey data from 3,990 women were used to investigate whether family planning service quality was associated with current modern contraceptive use in five cities in Kenya in 2010. In addition, audits of selected facilities and service provider interviews were conducted in 260 facilities, and exit interviews were conducted with family planning clients at 126 high-volume clinics. Individual- and facility-level data were linked according to the source of the woman's current method or other health service. Binomial regression was used to estimate adjusted prevalence ratios, and robust standard errors were used to account for clustering of observations within facilities. RESULTS: Sixty-five percent of women reported currently using a modern contraceptive method. Provider's solicitation of clients' method preferences, assistance with method selection, provision of information on side effects and good treatment of clients were positively associated with current modern contraceptive use (prevalence ratios, 1.1 each); associations were often stronger among younger and less educated women. CONCLUSION: Efforts to assist with method selection and to improve the content of contraceptive counseling and treatment of clients by providers have the potential to increase contraceptive use in urban Kenya.


Assuntos
Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/normas , Qualidade da Assistência à Saúde , Adolescente , Adulto , Atitude do Pessoal de Saúde , Cidades , Competência Clínica , Anticoncepcionais , Serviços de Planejamento Familiar/organização & administração , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia , Pessoa de Meia-Idade , Análise Multivariada , Satisfação do Paciente , Vigilância da População , Fatores Socioeconômicos , População Urbana , Saúde da Mulher , Adulto Jovem
16.
PLoS One ; 10(8): e0135062, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26295160

RESUMO

BACKGROUND: Accurate measurement of maternal mortality is needed to develop a greater understanding of the scale of the problem, to increase effectiveness of program planning and targeting, and to track progress. In the absence of good quality vital statistics, interim methods are used to measure maternal mortality. The purpose of this study is to document experience with three community-based interim methods that measure maternal mortality using verbal autopsy. METHODS: This study uses a post-census mortality survey, a sample vital registration with verbal autopsy, and a large-scale household survey to summarize the measures of maternal mortality obtained from these three platforms, compares and contrasts the different methodologies employed, and evaluates strengths and weaknesses of each approach. Included is also a discussion of issues related to death identification and classification, estimating maternal mortality ratios and rates, sample sizes and periodicity of estimates, data quality, and cost. RESULTS: The sample sizes vary considerably between the three data sources and the number of maternal deaths identified through each platform was small. The proportion of deaths to women of reproductive age that are maternal deaths ranged from 8.8% to 17.3%. The maternal mortality rate was estimable using two of the platforms while obtaining an estimate of the maternal mortality ratio was only possible using one of the platforms. The percentage of maternal deaths due to direct obstetric causes ranged from 45.2% to 80.4%. CONCLUSIONS: This study documents experiences applying standard verbal autopsy methods to estimate maternal mortality and confirms that verbal autopsy is a feasible method for collecting maternal mortality data. None of these interim methods are likely to be suitable for detecting short term changes in mortality due to prohibitive sample size requirements, and thus, comprehensive and continuous civil registration systems to provide high quality vital statistics are essential in the long-term.


Assuntos
Autopsia/métodos , Causas de Morte/tendências , Mortalidade Materna , Adolescente , Adulto , Bangladesh , Características da Família , Feminino , Humanos , Pessoa de Meia-Idade , Moçambique , Gravidez , Inquéritos e Questionários , Zâmbia
17.
Contraception ; 91(1): 39-43, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25288035

RESUMO

OBJECTIVE: We examined contraceptive use and dual protection in the postpartum period in a Prevention of Mother to Child Transmission population and whether it varied by HIV status. STUDY DESIGN: Data are from a prospective study, the South Africa HIV Antenatal Post-test Support Study. Pregnant participants were recruited from a government clinic in an urban township, and the analytic sample was 821. Following enrollment, participants were tested for HIV and administered a questionnaire at baseline and 14 weeks postpartum. We used generalized linear regression models to examine HIV status and use of modern contraceptives at 14 weeks. RESULTS: The risk ratio of condom use at 14 weeks postpartum was 1.66 [95% confidence interval (CI): 1.36-2.02] for HIV-positive compared to HIV-negative women. The risk ratio for dual protection (use of a condom and a hormonal method) was 1.96 (95% CI: 1.39-2.79) at 14 weeks for HIV-positive compared to HIV-negative women. CONCLUSIONS: HIV positive status may be a motivating factor for women to use condoms and dual protection. In this setting where HIV is highly prevalent, it is ever more important that women control the timing and limiting of births so as to preserve the health of the mother and child. IMPLICATION: HIV status may be an important motivating behavioral factor for women to use contraceptives and dual protection in the postpartum period.


Assuntos
Comportamento Contraceptivo , Infecções por HIV/prevenção & controle , Soropositividade para HIV , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Saúde da População Urbana , Adolescente , Adulto , Estudos de Coortes , Preservativos , Comportamento Contraceptivo/etnologia , Anticoncepcionais Femininos/administração & dosagem , Serviços de Planejamento Familiar/educação , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Infecções por HIV/transmissão , Soropositividade para HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Estudos Longitudinais , Período Pós-Parto , Prevalência , África do Sul/epidemiologia , Inquéritos e Questionários , Saúde da População Urbana/etnologia , Adulto Jovem
18.
Stud Fam Plann ; 45(4): 443-70, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25469929

RESUMO

In the field of international family planning, quality of care as a reproductive right is widely endorsed, yet we lack validated data-collection instruments that can accurately assess quality in terms of its public health importance. This study, conducted within 19 public and private facilities in Kisumu, Kenya, used the simulated client method to test the validity of three standard data-collection instruments used in large-scale facility surveys: provider interviews, client interviews, and observation of client-provider interactions. Results found low specificity and low positive predictive values in each of the three instruments for a number of quality indicators, suggesting that the quality of care provided may be overestimated by traditional methods of measurement. Revised approaches to measuring family planning service quality may be needed to ensure accurate assessment of programs and to better inform quality-improvement interventions.


Assuntos
Coleta de Dados/métodos , Serviços de Planejamento Familiar , Indicadores de Qualidade em Assistência à Saúde , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/organização & administração , Serviços de Planejamento Familiar/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Quênia , Avaliação de Resultados em Cuidados de Saúde/métodos , Melhoria de Qualidade , Qualidade da Assistência à Saúde
19.
Int Perspect Sex Reprod Health ; 40(4): 196-205, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25565347

RESUMO

CONTEXT: Gender inequality is a long-recognized driver of the HIV epidemic. However, few studies have investigated the association between gender-based power and HIV risk in India, which has the world's third largest HIV epidemic. METHODS: Population-based data collected in 2003 from 3,385 couples residing in Uttar Pradesh and Uttarakhand, North India, were used to examine associations between gender-based power (wife's autonomy and husband's inequitable gender attitudes) and indicators of couples' HIV risk (whether the husband had had premarital sex with someone other than his eventual spouse, extramarital sex in the past year or STI symptoms in the past year). Structural equation modeling was used to create composite variables for the gender-based power measures and test their associations with HIV risk measures. RESULTS: Twenty-four percent of husbands had had premarital sex, 7% had had extramarital sex in the past year and 6% had had STI symptoms in the past year. Structural equation models indicated that wives who reported higher levels of autonomy were less likely than other wives to have husbands who had had extramarital sex in the past year (direct association) or STI symptoms in the past year (indirect association). Moreover, husbands who endorsed more inequitable gender attitudes were more likely than others to report having had premarital sex with someone other than their spouse, which in turn was associated with having had extramarital sex and STI symptoms in the past year. CONCLUSIONS: If the associations identified in this study reflect a causal relationship between gender-based power and HIV risk behavior, then HIV prevention programs that successfully address inequitable gender roles may reduce HIV risks in North India.


Assuntos
Poder Psicológico , Sexismo/estatística & dados numéricos , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Cônjuges/psicologia , Adulto , Análise Fatorial , Feminino , Infecções por HIV , Humanos , Índia/epidemiologia , Relações Interpessoais , Entrevistas como Assunto , Masculino , Casamento , Pessoa de Meia-Idade , Fatores de Risco , Assunção de Riscos , Fatores Sexuais , Parceiros Sexuais/psicologia , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
20.
Health Care Women Int ; 35(2): 175-99, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23998760

RESUMO

Researchers in Sub-Saharan Africa have found that health facility factors influence client contraceptive use. We sought to understand how client-provider interactions, discussions of side effects, and HIV status influence women's contraceptive use postpartum. We conducted in-depth interviews with eight HIV negative clients and six HIV positive clients in Zulu, and with five nurses in English. Interviews were translated and transcribed into English. We created a codebook and coded all transcripts. Nurses and clients reported limited time to discuss contraception, side effects, and HIV. Nurses did not comply with national contraceptive policies and created unnecessary barriers to contraceptive use.


Assuntos
Comportamento Contraceptivo , Serviços de Planejamento Familiar/organização & administração , Cuidado Pós-Natal , Relações Profissional-Paciente , Adolescente , Adulto , Atitude do Pessoal de Saúde , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Período Pós-Parto , Pesquisa Qualitativa , Fatores Socioeconômicos , África do Sul , Adulto Jovem
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