| Researchers | Title | Publication | Abstract |
| VanLandingham, M. | Murder rates in New Orleans, La, 2004-2006. | Am J Public Health Sept 2007; 97(9):1614-1614. | Murder rates for New Orleans, La, during 2005 and 2006 were calculated with the best available population trajectories for these 2 atypical years. These calculations showed that the murder rate increased substantially during this period compared with 2004. The increase in 2005 from 2004 was 14%. The best estimate of the increase in the murder rate in 2006 compared with 2004 was 69%; the large increase in 2006 began during the second quarter of that year. |
| Keating J, Eisele TP, Bennett A, Johnson D, Macintyre K. | A description of malaria-related knowledge, perceptions, and practices in the Artibonite Valley of Haiti: implications for malaria control. | Am J Trop Med Hyg 2008 Feb;78(2):262-9. | A two-stage cluster survey (n = 200 households) was conducted in the Artibonite Valley of Haiti during the high malaria transmission season in November-December 2006. Knowledge, perceptions, and practices related to malaria were obtained from household representatives using a standardized questionnaire. Blood drops were obtained on filter paper from all household members more than one month of age (n = 714). Determinants of malaria infections and correct malaria-related knowledge were assessed using logistic regression. Respondents in households with more assets were significantly more likely than those in households with fewer assets to have correct malaria-related knowledge. Respondents from households with at least one malaria infection were less likely to have correct malaria-related knowledge. Older children (5-9 years of age) were shown to be at increased risk of malaria infection. Results suggest malaria control in Haiti should focus on enhanced surveillance and case management, with expanded information campaigns about malaria prevention and treatment options. |
| Hutchinson PL, Mahlalela X, Yukich J. | Mass media, stigma, and disclosure of HIV test results: multilevel analysis in the Eastern Cape, South Africa. | AIDS Educ Prev. Dec 2007. 19(6):489-510. | In this article, we examine the role of mass media and interpersonal communication in affecting knowledge of HIV/AIDS, reducing stigma, using condoms, and increasing the likelihood of disclosing HIV test results to sexual partners and family members. Data from a 2002 household survey in the Eastern Cape Province of South Africa are used to measure levels of stigma, interpersonal communication, willingness to disclosure HIV test results and condom use. We use a multilevel framework that accounts for the social context in which individuals access information, gauge social norms, and make decisions about the costs and benefits of HIV testing and disclosure. The results provide support for the positive effects of both media exposure and informal social networks on ideational factors, namely changes in knowledge and stigma, which lead to behavior change. Consistent with common models of health communication dynamics, these latter factors dominate decisions regarding disclosure of HIV test results and condom use. |
| Liu X, Hotchkiss DR, Bose S. | The effectiveness of contracting-out primary health care services in developing countries: a review of the evidence. | Health Policy Plann. Jan 2008. 23(1):1-13. | The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both programme and health systems performance in low-and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in
and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown. Moreover, little is known about the system-wide effects of contracting-out, which could be either positive or negative. Although the study results leave open the question of how contracting-out can be used as a policy tool to improve overall health system performance, the results indicate that the context in which contracting-out is implemented and the design features of the interventions are likely to greatly influence the chances for success. |
| Agha S, Karim AM, Balal A, Sosler S. | The impact of a reproductive health franchise on client satisfaction in rural Nepal. | Health Policy Plann. Sept 2007. 22(5):320-328. | This study evaluates the impact of a nurse and paramedic reproductive health franchise in rural Nepal on client satisfaction and utilization of services. A quasi-experimental study design, with baseline and follow-up measurements on nonequivalent control groups, was used to assess the effects of the intervention. The study collected data from exit interviews with male and female clients at clinics and from household interviews with married women. Our assessment covers the project's performance for about a year of actual implementation. Client satisfaction with the quality of services increased across a range of indicators at intervention clinics but not at control clinics. Overall satisfaction with services also increased only at intervention clinics but not at control clinics. Consistent with these changes, loyalty increased among clients of franchised clinics. The analysis showed a positive relationship between client satisfaction and loyalty. Although the project's implementation was examined over a relatively short period of time, there appears to have been a net positive effect of the intervention on obtaining family planning products from medical stores/pharmacies. The study shows that franchising reproductive health services increases a provider's interest in delivering better quality services in rural areas of a developing country. |
| Hill Z, Kirkwood B, Kendall C, Adjei E, Arthur P, Agyemang CT. | Factors that affect the adoption and maintenance of weekly vitamin A supplementation among women in Ghana. | Public Health Nutr. July 2007. 10(8):827-833. | Objective: To identify regimen, individual, community and cultural factors that affect adoption and adherence to weekly vitamin A supplementation in Ghana.
Design: Fifty semi-structured interviews were conducted with women who would be eligible for vitamin A supplementation, 30 with husbands, and 13 with drug sellers, birth attendants and health workers. Six focus group discussions were also conducted with women. These interviews were followed by a 4-month capsule trial with 60 women. Data from a previously conducted communication channel survey of 332 women were also reviewed.
Setting: The study was conducted in Kintampo District in central Ghana.
Subjects: Participants for the semi-structured interviews and focus groups were selected from four villages and the district capital, and women in the capsule trial were selected at random from two villages.
Results: Knowledge of vitamins was low and taking 'medicines' for long periods and when healthy is a new concept. In spite of this, long-term supplementation will be accepted if motives are explained, specific questions answered and clear instructions are given. Potential barriers included the idea of 'doctor' medicines as curative, false expectations of the supplement, forgetting to take the supplement, losing the supplement, travelling, lack of motivation, perceived side-effects, concerns that the supplement is really family planning or will make delivery difficult, and concerns about taking the supplement with other 'doctor' or herbal medicine, or when pregnant or breast-feeding, or if childless.
Conclusion: Successful supplementation programmes require appropriately designed information, education and communication strategies. Designing such strategies requires pre-programme formative research to uncover barriers and facilitators for supplementation. |
| Agha S, Gage AJ, Balal A. | Changes in perceptions of quality of and access to services among clients of a fractional franchise network in Nepal | J of Biosocial Science. May 2007. 39(3):341-54 | With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of and access to services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to increased provider willingness to remain part of the franchise and to abide by the standards of quality set by the franchiser. |
| Do MP, Koenig MA | Effect of family planning services on modern contraceptive method continuation in Vietnam | J of Biosocial Science. Mar 2007. 39(2):201-20 | Access to and quality of services have increasingly been the focus of family planning programme managers, implementers, and researchers in the developing world. In Vietnam, a country characterized by recent significant achievements in family planning, not much is known about the linkages between service accessibility and quality and contraceptive behaviour. Data for this study come from the Vietnam 1997 Demographic and Health Survey, with individual contraceptive use infomation recorded in the calendar section. Measures of access to and quality of services come from the Community/Health Facility Questionnaire, with key informant interviews and facility visits. The study focuses on the effects of the outreach programme and commune health centres on contraceptive methods discontinuation for three modern, temporary methods: the ID, oral pills, and condoms. Longer travel time to commune health centres is found to be associated with significantly increased risks of first- and all-method discontinuation for any reason, while residence in communities with higher quality health centres is associated with significantly lower risks of method discontinuation. Access to and quality of the outreach programme are, in contrast, not significant determinants of method discontinuation for any reason. Similar results are found for first- and all-method discontinuation for services-related reasons. The effects of programmatic factors are more pronounced among older women and during the first three months of method use. This study provides evidence for the importance of family planning services for contraceptive method continuation in Vietnam. The results also highlight the need for a thorough evaluation of the family planning outreach programme in terms of its facilitation of women's continued use of contraception. |
| Eisele TP, Macintyre K, Yukich J, Ghebremeskel T | Interpreting household survey data intended to measure insecticide-treated bednet coverage: results from two surveys in Eritrea | Malaria Journal. 2006. 5:36 | Background
As efforts are currently underway to roll-out insecticide-treated bednets (ITNs) to populations within malarious areas in Africa, there is an unprecedented need for data to measure to effectiveness of such programmes in terms of population coverage. This paper examines methodological issues to using household surveys to measure core Roll Back Malaria coverage indicators of ITN possession and use.
Methods
ITN coverage estimates within Anseba and Gash Barka Provinces from the 2002 Eritrean Demographic and Health Survey, implemented just prior to a large-scale ITN distribution programme, are compared to estimates from the same area from a sub-national Bednet Survey implemented 18 months later in 2003 after roll-out of the ITN programme. |
| Gage AJ, Guirlene Calixte M | Effects of the physical accessibility of maternal health services on their use in rural Haiti | Population Studies. Nov 2006. 60(3):271-88 | An analysis of data from the 2000 Demographic and Health Survey shows that little use is made of antenatal and delivery-care services in rural Haiti. After adjusting for individual-level factors, poor road conditions significantly reduce the likelihood of timely receipt of antenatal care and of four or more antenatal care visits, while the availability of a health centre within 5 kilometres significantly increases the odds of each outcome. The odds of being attended at delivery by trained medical personnel and of institutional delivery are significantly reduced by mountainous terrain and distance from the nearest hospital and are increased if a health worker providing antenatal care is present in the neighbourhood. Neighbourhood poverty reduces the likelihood of safe delivery care. The findings suggest that improving the use made of maternal healthcare services would require, among other things, improvement of the availability of services and road conditions and the reduction of poverty. |
| Thurman TR, Brown L, Richter L, Maharaj P, Magnani R | Sexual risk behavior among South African adolescents: is orphan status a factor? | AIDS & Behavior. Nov 2006. 10(6):627-35 | Abstract
There is concern that orphans may be at particular risk of HIV infection due to earlier age of sexual onset and higher likelihood of sexual exploitation or abuse; however, there is limited empirical evidence examining this phenomenon. Utilizing data from 1,694 black South African youth aged 14-18, of whom 31% are classified as orphaned, this analysis explores the relationship between orphan status and sexual risk. The analysis found both male and female orphans significantly more likely to have engaged in sex as compared to non-orphans (49% vs. 39%). After adjusting for socio-demographic variables, orphans were nearly one and one half times more likely than non-orphans to have had sex. Among sexually active youth, orphans reported younger age of sexual intercourse with 23% of orphans having had sex by 13 or younger compared to 15% of non-orphans. Programmatic implications of these findings for the care and protection of orphans are discussed. |
| Chopra M, Kendall C, Hill Z, Schaay N, Nkonki L, Doherty TM | Nothing new: responses to the introduction of antiretroviral drugs in South Africa | AIDS. Oct 2006. (20)15: 1975-1977 | Abstract
Interviews conducted in South Africa found that awareness of antiretroviral therapy was generally poor. Antiretroviral drugs were not perceived as new, but one of many alternative therapies for HIV/AIDS. Respondents had more detailed knowledge of indications, effects and how to access alternative treatments, which is bolstered by the active promotion and legitimization of alternative treatments. Many expressed a lack of excitement about the introduction of antiretroviral therapy, and little change in their attitudes concerning the epidemic. |
| Hutchinson P, Wheeler J | Advanced methods for evaluating the impact of family planning communication programs: evidence from Tanzania and Nepal | Studies in Family Planning. Sept 2006. 37(3):169-86 | Evaluations of national family planning communication campaigns are often complicated by nonrandomized research designs and self-reported measures of exposure to media messages, both of which can bias estimates of campaign effectiveness if suitable analytical methods are not employed. This study uses three methods to address these problems: (1) single-equation multiple regression analysis; (2) propensity score matching (PSM); and (3) maximum likelihood simultaneous equation models (SEM), namely bivariate probit. We used these methods to evaluate the impact of family planning health communication campaigns on the use of modern family planning methods, focusing primarily on the radio drama Zinduka! in Tanzania and Ghanti Heri Haad Nilaun in Nepal. We found that these methods led to substantially different estimates of the magnitude of the impact of these communication campaigns. Specifically, we found that self-reported exposure to each radio program was exogenously related to family planning use and that PSM and multiple regression analysis gave similar estimates in those situations. An indicator of exposure to any type of family planning message was found to be endogenous, in which case bivariate probit and PSM gave different estimates of program impact. Researchers should, therefore, pay close attention to the results of tests for endogeneity and identification that guide the appropriate use of the different methods. |
| Hotchkiss DR, Eisele TP, Djibuti M, Silvestre EA, Rukhadze N | Health system barriers to strengthening vaccine-preventable disease surveillance and response in the context of decentralization: evidence from Georgia | BMC Public Health. 2006. 6:175 | Background
A critical challenge in the health sector in developing countries is to ensure the quality and effectiveness of surveillance and public health response in an environment of decentralization. In Georgia, a country where there has been extensive decentralization of public health responsibilities over the last decade, an intervention was recently piloted to strengthen district-level local vaccine-preventable disease surveillance and response activities through improved capacity to analyze and use routinely collected data. The purpose of the study is 1) to assess the effectiveness of the intervention on motivation and perceived capacity to analyze and use information at the district-level, and 2) to assess the role that individual- and system-level factors play in influencing the effectiveness of the intervention.
Methods
A pre-post quasi-experimental research design is used for the quantitative evaluation. Data come from a baseline and two follow-up surveys of district-level health staff in 12 intervention and 3 control Center of Public Health (CPH) offices. These data were supplemented by record reviews in CPH offices as well as focus group discussions among CPH and health facility staff. RESULTS: The results of the study suggest that a number of expected improvements in perceived data availability and analysis occurred following the implementation of the intervention package, and that these improvements in analysis could be attributable to the intervention package. However, the study results also suggest that there exist several health systems barriers that constrained the effectiveness of the intervention in influencing the availability of data, analysis and response.
Conclusions
To strengthen surveillance and response systems in Georgia, as well as in other countries, donor, governments, and other stakeholders should consider how health systems factors influence investments to improve the availability of data, analysis, and response. Linking the intervention to broader health sector reforms in management processes and organizational culture will be critical to ensure that efforts designed to promote evidence-based decision-making are successful, especially as they are scaled up to the national level. |
| Thurman TR, Snider L, Boris N, Kalisa E, Nkunda Mugarira E, Ntaganira J, Brown L | Psychosocial support and marginalization of youth-headed households in Rwanda | AIDS Care. Apr 2006. 18(3):220-9 | Background
This research aims to characterize the psychosocial aspects of well-being among youth-headed households in Gikongoro, Rwanda, through examination of social support and marginalization. Data is presented on perceived availability of support from relatives, an unidentified adult, peers, and other community members and an index of social marginalization.
Methods
A total of 692 interviews were completed with youth-headed households age 13-24 who are beneficiaries of a basic needs program. Sixteen percent of youth reported there was no one they felt they could go to with a problem. In times of need, only 24% felt relatives would help them, while 57% felt neighbors would offer assistance. Most youth reported significant caring relationships: 73% reported access to a trusted adult who offers them advice and guidance, and most indicated close peer relationships. However, many youth also perceived a lack of community support, with 86% feeling rejected by the community and 57% feeling the community would rather hurt them than help them.
Conclusions
Social support is a low-cost critical resource for the care of vulnerable youth and an understanding of existing social support networks would enhance the design and implementation of psychosocial and community-based care initiatives. |
| Gage AJ, Van Rossem R | Attitudes toward the discontinuation of female genital cutting among men and women in Guinea | International J of Gynaecology & Obstetrics. Jan 2006. 92(1):92-6 | Objective
To investigate socioeconomic correlates of and gender differences in attitudinal support for the discontinuation of FGC in Guinea.
Method
Data from structured interviews of men aged 15-59 and women aged 15-49 years in the 1999 Demographic and Health Survey and multiple logistic regression methods were used to examine the relationship of socioeconomic factors and gender to attitudinal support for the discontinuation of FGC.
Results
More than 9 out of 10 women had undergone FGC. Attitudinal support for FGC discontinuation was more prevalent among men than women. The odds of supporting the discontinuation of FGC were negatively related to beliefs in social approval of and religious support for FGC and its enhancement of women's marriageability, the number of perceived advantages of FGC, and women's low socioeconomic status.
Conclusion
Community education, improvements in women's socioeconomic status and traditional and religious leader involvement would be critical for FGC eradication. |
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