Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania.

Science.gov (United States)

August, Furaha; Pembe, Andrea B; Kayombo, Edmund; Mbekenga, Columba; Axemo, Pia; Darj, Elisabeth

2015-01-01

Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

Directory of Open Access Journals (Sweden)

Sharad Onta

2014-08-01

Full Text Available Background: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results: Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs, distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions: Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study.

Science.gov (United States)

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P; Krettek, Alexandra

2014-01-01

Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

The effect of community maternal and newborn health family meetings on type of birth attendant and completeness of maternal and newborn care received during birth and the early postnatal period in rural Ethiopia.

Science.gov (United States)

Barry, Danika; Frew, Aynalem Hailemichael; Mohammed, Hajira; Desta, Binyam Fekadu; Tadesse, Lelisse; Aklilu, Yeshiwork; Biadgo, Abera; Buffington, Sandra Tebben; Sibley, Lynn M

2014-01-01

Maternal and newborn deaths occur predominantly in low-resource settings. Community-based packages of evidence-based interventions and skilled birth attendance can reduce these deaths. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) used community-level health workers to conduct prenatal Community Maternal and Newborn Health family meetings to build skills and care-seeking behaviors among pregnant women and family caregivers. Baseline and endline surveys provided data on a random sample of women with a birth in the prior year. An intention-to-treat analysis, plausible net effect calculation, and dose-response analysis examined increases in completeness of care (mean percentage of 17 maternal and newborn health care elements performed) over time and by meeting participation. Regression models assessed the relationship between meeting participation, completeness of care, and use of skilled providers or health extension workers for birth care-controlling for sociodemographic and health service utilization factors. A 151% increase in care completeness occurred from baseline to endline. At endline, women who participated in 2 or more meetings had more complete care than women who participated in fewer than 2 meetings (89% vs 76% of care elements; P care completeness (P care were nearly 3 times more likely to have used a skilled provider or health extension worker for birth care. Women who had additionally attended 2 or more meetings with family members were over 5 times as likely to have used these providers, compared to women without antenatal care and who attended fewer than 2 meetings (odds ratio, 5.19; 95% confidence interval, 2.88-9.36; P care by engaging women and family caregivers in self-care and care-seeking, resulting in greater completeness of care and more highly skilled birth care. © 2014 by the American College of Nurse-Midwives.

Determinants of skilled birth attendants for delivery in Nepal.

Science.gov (United States)

Baral, Y R; Lyons, K; Skinner, J; van Teijlingen, E R

2010-01-01

This review is to explore the factors affecting the uptake of skilled birth attendants for delivery and the issues associated with women's role and choices of maternal health care service for delivery in Nepal. Literature was reviewed across the globe and discussed in a Nepalese context. Delivery by Skilled Birth Attendance serves as an indicator of progress towards reducing maternal mortality worldwide, the fifth Millennium Development Goal. Nepal has committed to reducing its maternal mortality by 75% by 2015 through ensuring accessibility to the availability and utilisation of skilled care at every birth. The literature suggests that several socio-economic, cultural and religious factors play a significant role in the use of Skilled Birth Attendance for delivery in Nepal. Availability of transportation and distance to the health facility; poor infrastructure and lack of services; availability and accessibility of the services; cost and convenience; staff shortages and attitudes; gender inequality; status of women in society; women's involvement in decision making; and women's autonomy and place of residence are significant contributing factors for uptake of Skilled Birth Attendance for delivery in Nepal. The review found more quantitative research studies exploring the determinants of utilisation of the maternal health services during pregnancy in Nepal than qualitative studies. Findings of quantitative research show that different social demographic, economic, socio-cultural and religious factors are responsible for the utilisation of maternal health services but very few studies discussed how and why these factors are responsible for utilisation of skilled birth attendants in pregnancy. It is suggested that there is need for more qualitative research to explore the women's role and choice regarding use of skilled birth attendants services and to find out how and why these factors are responsible for utilisation of skilled birth attendants for delivery

Birth preparedness and complication readiness – a qualitative study among community members in rural Tanzania

Directory of Open Access Journals (Sweden)

Furaha August

2015-06-01

Full Text Available Background: Birth preparedness and complication readiness (BP/CR strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via

Birth preparedness and complication readiness – a qualitative study among community members in rural Tanzania

Science.gov (United States)

August, Furaha; Pembe, Andrea B.; Kayombo, Edmund; Mbekenga, Columba; Axemo, Pia; Darj, Elisabeth

2015-01-01

Background Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers

The experience of being a traditional midwife: relationships with skilled birth attendants.

Science.gov (United States)

Dietsch, Elaine

2010-01-01

This article focuses on an unexpected finding of a research project which explored the experience of being a traditional midwife. The unexpected finding was that traditional midwives often perceive skilled (professional) birth attendants to be abusive of both them and the women who are transferred to hospital for emergency obstetric care. Eighty-four traditional midwives in the Western Province of Kenya were interviewed individually or in groups with a Bukusu/Kiswahili/English-speaking interpreter. Interviews were audiotaped and the English components were transcribed verbatim. Interview transcripts and observations were thematically analysed. A minority of relationships between traditional midwives and skilled birth attendants were based on mutual respect and collaborative practice. However, the majority of encounters with skilled birth attendants were perceived by the traditional midwives to be abusive for them and the women requiring emergency obstetric care. In the interests of improving health outcomes for women and their newborns, interpersonal skills, including maintaining respectful communication and relationships must be a core competency for all caregivers. Providing opportunities for reciprocal learning and strategies to enhance relationships between traditional midwives and skilled birth attendants are recommended. Current global strategies to reduce maternal and newborn mortality by increasing the number of women birthing with a skilled (professional) birth attendant in an enabling environment may be limited while the reasons for traditional midwives being the caregiver of choice for the majority of women living in areas such as Western Kenya remain unaddressed.

Birth spacing of pregnant women in Nepal: A community-based study

Directory of Open Access Journals (Sweden)

Rajendra Karkee

2016-09-01

Full Text Available BackgroundOptimal birth spacing has health advantages for both mother and child. In developing countries, shorter birth intervals are common and associated with social, cultural and economic factors, as well as a lack of family planning. This study investigated the first birth interval after marriage and preceding interbirth interval in Nepal.MethodsA community-based prospective cohort study was conducted in the Kaski district of Nepal. Information on birth spacing, demographic and obstetric characteristics was obtained from 701 pregnant women using a structured questionnaire. Logistic regression analyses were performed to ascertain factors associated with short birth spacing.ResultsAbout 39% of primiparous women gave their first child birth within one year of marriage and 23% of multiparous women had short preceding interbirth intervals (<24 months. The average birth spacing among the multiparous group was 44.9 (SD 21.8 months. Overall, short birth spacing appeared to be inversely associated with advancing maternal age.For the multiparous group, Janajati and lower caste women, and those whose newborn was female, were more likely to have short birth spacing.ConclusionsThe preceding interbirth interval was relatively long in the Kaski district of Nepal and tended to be associated with maternal age, caste, and sex of newborn infant. Optimal birth spacing programs should target Janajati and lower caste women, along with promotion of gender equality in society.

Patterns of birth weight at a community level

African Journals Online (AJOL)

user

identified a one-year live birth cohort of 8,273 in Jimma, Illubabor and Keffa ... METHODS: This was a community-based longitudinal study, which attempts to ... RESULTS: The results of the study found an estimated low birth weight rate ... mothers' experience of previous child deaths. ... births occur at home. ..... assessment.

Skilled attendance at delivery; how skilled are institutional birth attendants? : An explorative study on birth attendants at Bansang Hospital, The Gambia

OpenAIRE

Kreyberg, Ina; Helsingen, Lise Mørkved

2010-01-01

Abstract Background: As reflected in the United Nations Millennium Development Goals (UN MDG 5), reducing maternal mortality represents an important area of concern. The common causes of maternal deaths may be preventable and treatable by having access to emergency obstetric care (EmOC), including skilled birth attendance (SBA), when needed. Measuring the presence of a birth attendant has been the main focus until now, not their skills and qualifications, and by this we cannot presuppose ...

Utilization of skilled birth attendants at delivery among urban women ...

African Journals Online (AJOL)

Background: Maternal mortality ratio remains high in Nigeria and the Presence of skilled birth attendants at delivery is a key strategy towards reducing the rate. Objective: To determine the rate and factors that affect utilization of skilled birth attendants (SBA) among Igbo women in Nnewi, South-Eastern Nigeria. Methodology: ...

Factors Affecting Utilization of Skilled Birth Attendants by Women in ...

African Journals Online (AJOL)

This underscores the need to investigate factors responsible for low use of skilled attendants at birth. The main purpose of the study was to identify factors affecting utilization of skilled attendants at birth by pregnant women in Kasama district in order to help contribute to the reduction of maternal and child complications.

Evaluation of simulation-based training on the ability of birth attendants to correctly perform bimanual compression as obstetric first aid.

Science.gov (United States)

Andreatta, Pamela; Gans-Larty, Florence; Debpuur, Domitilla; Ofosu, Anthony; Perosky, Joseph

2011-10-01

Maternal mortality from postpartum hemorrhage remains high globally, in large part because women give birth in rural communities where unskilled (traditional birth attendants) provide care for delivering mothers. Traditional attendants are neither trained nor equipped to recognize or manage postpartum hemorrhage as a life-threatening emergent condition. Recommended treatment includes using uterotonic agents and physical manipulation to aid uterine contraction. In resource-limited areas where Obstetric first aid may be the only care option, physical methods such as bimanual uterine compression are easily taught, highly practical and if performed correctly, highly effective. A simulator with objective performance feedback was designed to teach skilled and unskilled birth attendants to perform the technique. To evaluate the impact of simulation-based training on the ability of birth attendants to correctly perform bimanual compression in response to postpartum hemorrhage from uterine atony. Simulation-based training was conducted for skilled (N=111) and unskilled birth attendants (N=14) at two regional (Kumasi, Tamale) and two district (Savelugu, Sene) medical centers in Ghana. Training was evaluated using Kirkpatrick's 4-level model. All participants significantly increased their bimanual uterine compression skills after training (p=0.000). There were no significant differences between 2-week delayed post-test performances indicating retention (p=0.52). Applied behavioral and clinical outcomes were reported for 9 months from a subset of birth attendants in Sene District: 425 births, 13 postpartum hemorrhages were reported without concomitant maternal mortality. The results of this study suggest that simulation-based training for skilled and unskilled birth attendants to perform bi-manual uterine compression as postpartum hemorrhage Obstetric first aid leads to improved applied procedural skills. Results from a smaller subset of the sample suggest that these skills

Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan.

Science.gov (United States)

Tappis, Hannah; Koblinsky, Marge; Doocy, Shannon; Warren, Nicole; Peters, David H

2016-01-01

The objective of this study was to assess the association between health facility characteristics and other individual/household factors with a woman's likelihood of skilled birth attendance in north-central Afghanistan. Data from a 2010 household survey of 6879 households in 9 provinces of Afghanistan were linked to routine facility data. Hierarchical logistic regression models were used to assess determinants of skilled birth attendance. Women who reported having at least one antenatal visit with a skilled provider were 5.6 times more likely to give birth with a skilled attendant than those who did not. The odds of skilled birth attendance were 84% higher for literate women than those without literacy skills and 79% higher among women in the upper 2 wealth quintiles than women in the poorest quintile. This study did not show any direct linkages between facility characteristics and skilled birth attendance but provided insights into why studies assuming that women seek care at the nearest primary care facility may lead to misinterpretation of care-seeking patterns. Findings reveal a 36 percentage point gap between women who receive skilled antenatal care and those who received skilled birth care. Nearly 60% of women with a skilled attendant at their most recent birth bypassed the nearest primary care facility to give birth at a more distant primary care facility, hospital, or private clinic. Distance and transport barriers were reported as the most common reasons for home birth. Assumptions that women who give birth with a skilled attendant do so at the closest health facility may mask the importance of supply-side determinants of skilled birth attendance. More research based on actual utilization patterns, not assumed catchment areas, is needed to truly understand the factors influencing care-seeking decisions in both emergency and nonemergency situations and to adapt strategies to reduce preventable mortality and morbidity in Afghanistan. © 2016 by the American

Effect of life skills building education and micronutrient supplements provided from preconception versus the standard of care on low birth weight births among adolescent and young Pakistani women (15-24 years): a prospective, population-based cluster-randomized trial.

Science.gov (United States)

Baxter, Jo-Anna B; Wasan, Yaqub; Soofi, Sajid B; Suhag, Zamir; Bhutta, Zulfiqar A

2018-05-31

Risk factors known to impact maternal and newborn nutrition and health can exist from adolescence. If an undernourished adolescent girl becomes pregnant, her own health and pregnancy are at an increased risk for adverse outcomes. Offering preconception care from adolescence could provide an opportunity for health and nutrition promotion to improve one's own well-being, as well as future pregnancy outcomes and the health of the next generation. The Matiari emPowerment and Preconception Supplementation (MaPPS) Trial is a population-based two-arm, cluster-randomized, controlled trial of life skills building education and multiple micronutrient supplementation provided in a programmatic context to evaluate the impact on pre-identified nutrition and health outcomes among adolescent and young women (15-24 years) in Matiari district Pakistan, and the infants born to them within the context of the trial. The primary aim is to assess the effect of the intervention on the prevalence of low birth weight births (< 2500 g). The intervention includes bi-monthly life skills building education provided from preconception, and supplementation with multiple micronutrients during preconception (twice-weekly), pregnancy (daily), and post-partum (daily to 6 months). The standard of care includes non-regulated community-based health sessions and daily iron and folic acid supplementation during pregnancy. Additional outcome information will also be collected at set time periods. Among participants, these relate to nutrition (anthropometry, nutritional status), morbidity, and mortality. Among infants, these include birth outcomes (stillbirth, preterm birth, length of gestation, small for gestational age, birth defects), anthropometry, morbidity, and mortality. Preconception care from adolescence that includes interventions targeting life skills development and nutrition is suggested to be important to improving the health and nutrition of adolescent and young women and their future

Impact of Birth Preparedness and Complication Readiness Interventions on Birth with a Skilled Attendant : A Systematic Review

NARCIS (Netherlands)

Miltenburg, Andrea Solnes; Roggeveen, Yadira; Shields, Laura; van Elteren, Marianne; van Roosmalen, Jos; Stekelenburg, Jelle; Portela, Anayda

2015-01-01

Background Increased preparedness for birth and complications is an essential part of antenatal care and has the potential to increase birth with a skilled attendant. We conducted a systematic review of studies to assess the effect of birth preparedness and complication readiness interventions on

Capacity building of skilled birth attendants: a review of pre-service education curricula.

Science.gov (United States)

Adegoke, Adetoro A; Mani, Safiyanu; Abubakar, Aisha; van den Broek, Nynke

2013-07-01

to assess the level, type and content of pre-service education curricula of health workers providing maternity services against the ICM global standards for Midwifery Education and Essential competencies for midwifery practice. We reviewed the quality and relevance of pre-service education curricula of four cadres of health-care providers of maternity care in Northern Nigeria. we adapted and used the ICM global standards for Midwifery Education and Essential competencies for midwifery practice to design a framework of criteria against which we assessed curricula for pre-service training. We reviewed the pre-service curricula for Nurses, Midwives, Community Health Extension Workers (CHEW) and Junior Community Health Extension Workers (JCHEW) in three states. Criteria against which the curricula were evaluated include: minimum entry requirement, the length of the programme, theory: practice ratio, curriculum model, minimum number of births conducted during training, clinical experience, competencies, maximum number of students allowable and proportion of Maternal, Newborn and Child Health components (MNCH) as part of the total curriculum. four pre-service education programmes were reviewed; the 3 year basic midwifery, 3 year basic nursing, 3 year Community Health Extension Worker (CHEW) and 2 year Junior Community Health Extension Worker (JCHEW) programme. Findings showed that, none of these four training curricula met all the standards. The basic midwifery curriculum most closely met the standards and competencies set out. The nursing curriculum showed a strong focus on foundations of nursing practice, theories of nursing, public health and maternal newborn and child health. This includes well-defined modules on family health which are undertaken from the first year to the third year of the programme. The CHEW and JCHEW curricula are currently inadequate with regard to training health-care workers to be skilled birth attendants. although the midwifery curriculum

Socio-demographic determinants of skilled birth attendant at delivery in rural southern Ghana.

Science.gov (United States)

Manyeh, Alfred Kwesi; Akpakli, David Etsey; Kukula, Vida; Ekey, Rosemond Akepene; Narh-Bana, Solomon; Adjei, Alexander; Gyapong, Margaret

2017-07-11

Maternal mortality is the subject of the United Nations' fifth Millennium Development Goal, which is to reduce the maternal mortality ratio by three quarters from 1990 to 2015. The giant strides made by western countries in dropping of their maternal mortality ratio were due to the recognition given to skilled attendants at delivery. In Ghana, nine in ten mothers receive antenatal care from a health professional whereas only 59 and 68% of deliveries are assisted by skilled personnel in 2008 and 2010 respectively. This study therefore examines the determinants of skilled birth attendant at delivery in rural southern Ghana. This study comprises of 1874 women of reproductive age who had given birth 2 years prior to the study whose information were extracted from the Dodowa Health and Demographic Surveillance System. The univariable and multivariable associations between exposure variables (risk factors) and skilled birth attendant at delivery were explored using logistic regression. Out of a total of 1874 study participants, 98.29% of them receive antenatal care services during pregnancy and only 68.89% were assisted by skilled person at their last delivery prior to the survey. The result shows a remarkable influence of maternal age, level of education, parity, socioeconomic status and antenatal care attendance on skilled attendants at delivery. Although 69% of women in the study had skilled birth attendants at delivery, women from poorest households, higher parity, uneducated, and not attending antenatal care and younger women were more likely to deliver without a skilled birth attendants at delivery. Future intervention in the study area to bridge the gap between the poor and least poor women, improve maternal health and promote the use of skilled birth at delivery is recommended.

Further Examination of Two Measures of Community-Based Social Skills for Adolescents and Young Adults with Emotional and Behavioral Disorders.

Science.gov (United States)

Bullis, Michael; Davis, Cheryl

1997-01-01

Two measures of community-based social behavior for adolescents and young adults with emotional and behavioral disorders, the male and female forms of the Test of Community-Based Social Skill Knowledge and the Scale of Community-Based Social Skill Performance, were examined. Results found the measures yielded acceptable reliabilities and exhibited…

Rural community birth: Maternal and neonatal outcomes for planned community births among rural women in the United States, 2004-2009.

Science.gov (United States)

Nethery, Elizabeth; Gordon, Wendy; Bovbjerg, Marit L; Cheyney, Melissa

2017-11-13

Approximately 22% of women in the United States live in rural areas with limited access to obstetric care. Despite declines in hospital-based obstetric services in many rural communities, midwifery care at home and in free standing birth centers is available in many rural communities. This study examines maternal and neonatal outcomes among planned home and birth center births attended by midwives, comparing outcomes for rural and nonrural women. Using the Midwives Alliance of North America Statistics Project 2.0 dataset of 18 723 low-risk, planned home, and birth center births, rural women (n = 3737) were compared to nonrural women. Maternal outcomes included mode of delivery (cesarean and instrumental delivery), blood transfusions, severe events, perineal lacerations, or transfer to hospital and a composite (any of the above). The primary neonatal outcome was a composite of early neonatal intensive care unit or hospital admissions (longer than 1 day), and intrapartum or neonatal deaths. Analysis involved multivariable logistic regression, controlling for sociodemographics, antepartum, and intrapartum risk factors. Rural women had different risk profiles relative to nonrural women and reduced risk of adverse maternal and neonatal outcomes in bivariable analyses. However, after adjusting for risk factors and confounders, there were no significant differences for a composite of maternal (adjusted odds ratio [aOR] 1.05 [95% confidence interval {CI} 0.93-1.19]) or neonatal (aOR 1.13 [95% CI 0.87-1.46]) outcomes between rural and nonrural pregnancies. Among this sample of low-risk women who planned midwife-led community births, no increased risk was detected by rural vs nonrural status. © 2017 Wiley Periodicals, Inc.

Management Information Systems Students' Perception of Skills and Competencies - Towards Knowledge Based Community

Directory of Open Access Journals (Sweden)

Alev ELÇİ

2016-12-01

Full Text Available The increasing usage of Information and Communication Technologies in official borders of our business lives, starting from e-government and e-commerce applications, spreading towards our daily personal lives has made it difficult to ignore the importance of Management Information Systems (MIS. MIS, initially taught as a course in different disciplines, has now started to develop as a standalone interdisciplinary academic program in higher education. Besides curriculum standards suggestions and necessary skills and competencies for MIS education identified by academic and professional organizations, students' perceptions in these topics are also important. Thus while developing towards knowledge based community, the aim of this research is to identify MIS students' perceptions of essential skills and competencies in their educational, proffesional and personal lives. The sample group of this study are the students that are a member of social media MIS groups. The gathered quantitative data has been analyzed by an online survey. As a result, it has been evident that students find that information technical skills and competencies are crucial. The skills required for transition to knowledge based community; global working, multicultural, social responsibility, civic awareness, equal opportunity, gender and environmental awareness comes later.

Mastering the soft skills in the implementation of work based learning among community college students

Science.gov (United States)

Ali, Azita Binti; Islamiah Rosli, Doria; Sujadi, Imam; Usodo, Budi; Adie Perdana, Fengky

2017-01-01

Emphasizing the aspects of soft skills among students is an important element to produce graduates who are competitive when facing any situations in the workplace. Various efforts have been taken by the Ministry of Education (MOE) and the Ministry of Higher Education Malaysia (MOHE) to improve the education system in Malaysia. Learning methods were introduced to ensure the education systems achieve the educational goals and to produce individuals who are well-balanced with spiritually, emotionally and physically. However, the issue of unemployment among graduates often being spoken in the community and it was regarded as a failure of educational institutions to produce quality graduates. Thus, the method of Work-Based Learning (WBL) was seen as a way to improve the soft skills among the graduates. The study was conducted using quantitative research survey as the design of the study used a questionnaire that was adapted as an instrument. Data were analysed using Statistical Package of Social Science (SPSS) version 20.0. The respondents were consisted of 97 students who attended WBL programs at the community college. Data were obtained from questionnaires using descriptive statistics for the calculation of the mean and one-way ANOVA test. The findings of the level of soft skills among community colleges were high where the communication skills obtained (mean = 4.1218), critical and problem solving skills (mean = 4.0946), teamwork skills (mean = 4.2297), learning and information management (mean = 4.1219), entrepreneurial skills (mean = 4.0240), professional ethics and moral (mean = 3.9410) and leadership skills (mean = 4.2104). The findings also showed the differences in term of communication skills among the community colleges. This study was significant to the community colleges to identify the level of soft skills among students who performed WBL methods in order to reduce the number of unemployment.

A decomposition analysis of change in skilled birth attendants, 2003 to 2008, Ghana Demographic and Health Surveys.

Science.gov (United States)

Bosomprah, Samuel; Aryeetey, Genevieve Cecelia; Nonvignon, Justice; Adanu, Richard M

2014-12-24

The single most critical intervention to improve maternal and neonatal survival is to ensure that a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of an emergency. This study aims to describe changes in percentage of skilled birth attendants in Ghana and to identify causes of the observed changes as well as the contribution of different categories of mother's characteristics to these changes. This study uses two successive nationally representative household surveys: the 2003 and 2008 Ghana Demographic and Health Surveys (GDHS). The two datasets have comparable information on household characteristics and skilled attendants at birth at the time of the survey. The 2003 GDHS database includes information on 6,251 households and 3639 live births in the five years preceding the survey, whereas the 2008 GDHS database had information on11, 778 households and 2909 live births in the five years preceding the survey. A decomposition approach was used to explain the observed change in percentage of skilled birth attendants. Random-effects generalized least square regression was used to explore the effect of changes in population structure in respect of the mother's characteristics on percentage of skilled birth attendants over the period. Overall, the data showed absolute gain in the proportion of births attended by a health professional from 47.1% in 2003 to 58.7% in 2008, which represents 21.9% of gap closed to reach universal coverage. The increase in skilled birth attendants was found to be caused by changes in general health behaviour. The gain is regardless of the mother's characteristics. The structural change in the proportion of births in respect of birth order and mother's education had little effect on the change in percentage of skilled birth attendants. Improvement in general health behaviour can potentially contribute to an accelerated increase in proportion

Level of Soft Skill in the Implementation of Work-Based Learning among Community College Students

Directory of Open Access Journals (Sweden)

Ali Azita Binti

2018-01-01

Full Text Available The issue of graduate unemployment often crops up in the mass media; and more often than not, the discussions have centred on the failure of tertiary educational institutions to churn out quality graduates. Thus, the method of work-based learning (WBL is seen as a way to improve the soft skills of the graduates. The study was conducted using quantitative research survey; the design of the study used an adapted questionnaire as an instrument. Data were analysed using Statistical Package of Social Science (SPSS version 20. The respondents consisted of 97 students who attended WBL programmes at a community college. Descriptive statistics was used to extract data from the questionnaires for the calculation of mean. The findings reveal that the level of soft skills among community college students was high, and they include these abilities: communication skills, problem-solving skills, learning and information management, professional ethics skills and leadership skills.

Effectiveness of community based Safe Motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania.

Science.gov (United States)

Mushi, Declare; Mpembeni, Rose; Jahn, Albrecht

2010-04-01

In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania. This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues. Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (rho utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

The effectiveness of three sets of school-based instructional materials and community training on the acquisition and generalization of community laundry skills by students with severe handicaps.

Science.gov (United States)

Morrow, S A; Bates, P E

1987-01-01

This study examined the effectiveness of three sets of school-based instructional materials and community training on acquisition and generalization of a community laundry skill by nine students with severe handicaps. School-based instruction involved artificial materials (pictures), simulated materials (cardboard replica of a community washing machine), and natural materials (modified home model washing machine). Generalization assessments were conducted at two different community laundromats, on two machines represented fully by the school-based instructional materials and two machines not represented fully by these materials. After three phases of school-based instruction, the students were provided ten community training trials in one laundromat setting and a final assessment was conducted in both the trained and untrained community settings. A multiple probe design across students was used to evaluate the effectiveness of the three types of school instruction and community training. After systematic training, most of the students increased their laundry performance with all three sets of school-based materials; however, generalization of these acquired skills was limited in the two community settings. Direct training in one of the community settings resulted in more efficient acquisition of the laundry skills and enhanced generalization to the untrained laundromat setting for most of the students. Results of this study are discussed in regard to the issue of school versus community-based instruction and recommendations are made for future research in this area.

Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis.

Science.gov (United States)

Jacobs, Choolwe; Moshabela, Mosa; Maswenyeho, Sitali; Lambo, Nildah; Michelo, Charles

2017-01-01

Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother's ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to

Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania

Directory of Open Access Journals (Sweden)

Jahn Albrecht

2010-04-01

Full Text Available Abstract Background In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%, only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania. Method This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs. Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues. Results Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (ρ Conclusion The study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

DEVELOPING PROBLEM SOLVING SKILLS FOR LIFELONG LEARNING THROUGH WORK-BASED LEARNING AMONG COMMUNITY COLLEGE STUDENTS

OpenAIRE

Wan Azlinda Wan Mohamed; Badrul Omar; Mohd Faroul Rafiq Romli

2010-01-01

Many training providers are working to improve their curricula to meet the demand of today’s industries. The Malaysian College Communities, one of the major providers for lifelong learning program, had introduced the Work-Based Learning (WBL) concept since 2007 to ensure that their graduates met these demands. One of the key skills required by industry is problem solving skill. The ability to solve a complex or an ill-structured work problem in the workplace is the kind of skill demanded at a...

Motor skills at 23 years of age in young adults born preterm with very low birth weight.

Science.gov (United States)

Husby, Ingrid Marie; Skranes, Jon; Olsen, Alexander; Brubakk, Ann-Mari; Evensen, Kari Anne I

2013-09-01

Motor skills have previously not been reported in young adults born with very low birth weight (VLBW), although they are commonly reported in children and adolescents. To compare fine and gross motor skills in VLBW young adults with matched term-born controls, and to study longitudinal changes in the VLBW group. A geographically based follow-up study of a VLBW group and a control group. Thirty-six VLBW (birth weight ≤ 1500 g) young adults, including four participants with cerebral palsy (CP), and 37 matched controls (birth weight ≥ 10th centile) were examined at 14 and 23 years of age. Fine and gross motor skills were assessed using Grooved Pegboard test (GP), Trail Making Test-5 (TMT-5), Movement Assessment Battery for Children-2 (Movement ABC-2) and High-level Mobility Assessment Tool (HiMAT). VLBW young adults were slower than controls on GP (p = 0.026) and TMT-5 (p motor skills in the VLBW group. The proportion of participants with motor problems did not change between age 14 and 23. After exclusion of participants with CP, scores were essentially the same. VLBW young adults had overall poorer fine and gross motor skills compared with controls. Reduced speed seemed to be an underlying problem. Longitudinal findings indicate that VLBW children have not outgrown their motor problems when entering adulthood. Copyright © 2013 Elsevier Ltd. All rights reserved.

Change in Population Characteristics and Teen Birth Rates in 77 Community Areas: Chicago, Illinois, 1999-2009.

Science.gov (United States)

Gunaratne, Shauna; Masinter, Lisa; Kolak, Marynia; Feinglass, Joe

2015-01-01

We analyzed community area differences in teen births in Chicago, Illinois, from 1999 to 2009. We analyzed the association between changes in teen birth rates and concurrent measures of community area socioeconomic and demographic change. Mean annual changes in teen birth rates in 77 Chicago community areas were correlated with concurrent census-based population changes during the decade. Census measures included changes in race/ethnicity, adult high school dropouts, poverty or higher-income households, crowded housing, unemployment, English proficiency, foreign-born residents, or residents who moved in the last five years. We included non-collinear census measures with a pbirths in a stepwise multiple linear regression model. Teen birth rates in Chicago fell faster than the overall birth rates, from 85 births per 1,000 teens in 1999 to 57 births per 1,000 teens in 2009. There were strong positive associations between increases in the percentage of residents who were black and Hispanic, poor, without a high school diploma, and living in crowded housing, and a negative association with an increase in higher-income households. Population changes in poverty, Hispanic population, and high school dropouts were the only significant measures in the final model, explaining almost half of the variance in teen birth rate changes. The study provides a model of census-based measures that can be used to evaluate predicted vs. observed rates of change in teen births across communities, offering the potential to more appropriately prioritize public health resources for preventing unintended teen pregnancy.

Insights on skilled attendance at birth in Malawi - the findings of a ...

African Journals Online (AJOL)

Increasing the number of women who access skilled attendance at birth is the goal of many developing countries including Malawi. The Skilled Attendance for Everyone (SAFE) international research programme coordinated by the Dugald Baird Centre for research on Women\\'s Health at the University of Aberdeen, ...

Associations among family socioeconomic status, EEG power at birth, and cognitive skills during infancy

Directory of Open Access Journals (Sweden)

Natalie H. Brito

2016-06-01

Full Text Available Past research has demonstrated links between cortical activity, measured via EEG power, and cognitive processes during infancy. In a separate line of research, family socioeconomic status (SES has been strongly associated with children’s early cognitive development, with socioeconomic disparities emerging during the second year of life for both language and declarative memory skills. The present study examined associations among resting EEG power at birth, SES, and language and memory skills at 15-months in a sample of full-term infants. Results indicate no associations between SES and EEG power at birth. However, EEG power at birth was related to both language and memory outcomes at 15-months. Specifically, frontal power (24–48 Hz was positively correlated with later Visual Paired Comparison (VPC memory scores. Power (24–35 Hz in the parietal region was positively correlated with later PLS-Auditory Comprehension language scores. These findings suggest that SES disparities in brain activity may not be apparent at birth, but measures of resting neonatal EEG power are correlated with later memory and language skills independently of SES.

Early developmental influences on self-esteem trajectories from adolescence through adulthood: Impact of birth weight and motor skills.

Science.gov (United States)

Poole, Kristie L; Schmidt, Louis A; Ferro, Mark A; Missiuna, Cheryl; Saigal, Saroj; Boyle, Michael H; Van Lieshout, Ryan J

2018-02-01

While the trajectory of self-esteem from adolescence to adulthood varies from person to person, little research has examined how differences in early developmental processes might affect these pathways. This study examined how early motor skill development interacted with preterm birth status to predict self-esteem from adolescence through the early 30s. We addressed this using the oldest known, prospectively followed cohort of extremely low birth weight (self-report, and self-esteem was reported during three follow-up periods (age 12-16, age 22-26, and age 29-36). We found that birth weight status moderated the association between early motor skills and self-esteem. Stable over three decades, the self-esteem of normal birth weight participants was sensitive to early motor skills such that those with poorer motor functioning manifested lower self-esteem, while those with better motor skills manifested higher self-esteem. Conversely, differences in motor skill development did not affect the self-esteem from adolescence to adulthood in individuals born at extremely low birth weight. Early motor skill development may exert differential effects on self-esteem, depending on whether one is born at term or prematurely.

BIRTH WEIGHT : A COMMUNITY PERSPECTIVE

Directory of Open Access Journals (Sweden)

J P SRIVASTAVA

2003-06-01

Full Text Available India has a dubious distinction of belonging to the top bracket of countries with a very high under-5 Mortality Rate (U5MR of above 96/1000 live births. The U5MR considered the single most significant basic indicator of health status of a community, is proportional to the Infant Mortality Rate (IMR which in turn is contributed to directly and indirectly by the incidence of low Birth Weight (LB W.About 25 million LB W are born each year consisting 17% of all live births,nearly 95% of them in developing countries. About 26% of newborns are LBW in India, and indeed over 16% in those countries with very high U5MR.Both preterm and small-for-dates almost equally make up this category of vulnerable infants predisposed to asphyxia, feeding problems, anemia and growth failure. Considering the close relationship of birth weight with perinatal and infant morbidity as well as mortality, it is crucial to identify the liigh risk groups of low birth weight babies as early as possible.Unfortunately, in a community where 80% of newborns never get to have their weight measured, this itself is a tall order. In our society, the cry of the newborn is greeted with anxious queries about the sex of the baby and not his well­being and potential for healthy survival. The basic concept of the importance of birth weight is missing even among educated families. Indeed, it is as if the weighing machine has no place in the requirements at childbirth. In the absence of this basic facility, field workers and TBAs must report to other means to identify babies at risk. Mid-arm circumference, thigh circumference, foot length, and skin-fold thickness etc. are measurements that have been correlated satisfactorily with the baby’s weight. Simple tools like coloured strips have been developed and these show promise of applicability in field situation for identification of LB W by TBAs for early referral.

BIRTH WEIGHT : A COMMUNITY PERSPECTIVE

Directory of Open Access Journals (Sweden)

J P SRIVASTAVA

2003-06-01

Full Text Available India has a dubious distinction of belonging to the top bracket of countries with a very high under-5 Mortality Rate (U5MR of above 96/1000 live births. The U5MR considered the single most significant basic indicator of health status of a community, is proportional to the Infant Mortality Rate (IMR which in turn is contributed to directly and indirectly by the incidence of low Birth Weight (LB W.About 25 million LB W are born each year consisting 17% of all live births,nearly 95% of them in developing countries. About 26% of newborns are LBW in India, and indeed over 16% in those countries with very high U5MR.Both preterm and small-for-dates almost equally make up this category of vulnerable infants predisposed to asphyxia, feeding problems, anemia and growth failure.Considering the close relationship of birth weight with perinatal and infant morbidity as well as mortality, it is crucial to identify the liigh risk groups of low birth weight babies as early as possible.Unfortunately, in a community where 80% of newborns never get to have their weight measured, this itself is a tall order. In our society, the cry of the newborn is greeted with anxious queries about the sex of the baby and not his well­being and potential for healthy survival. The basic concept of the importance of birth weight is missing even among educated families. Indeed, it is as if the weighing machine has no place in the requirements at childbirth. In the absence of this basic facility, field workers and TBAs must report to other means to identify babies at risk. Mid-arm circumference, thigh circumference, foot length, and skin-fold thickness etc. are measurements that have been correlated satisfactorily with the baby’s weight. Simple tools like coloured strips have been developed and these show promise of applicability in field situation for identification of LB W by TBAs for early referral.

Community Context, Land Use, and First Birth

Science.gov (United States)

Ghimire, Dirgha J.; Axinn, William G.

2010-01-01

This article examines the influence of community context and land use on the monthly odds of first birth in a society in the midst of dramatic fertility transition. The theoretical framework guiding our work predicts that proximity to nonfamily services should delay first births by creating opportunities for competing nonfamily activities and…

Prevention of postpartum hemorrhage at home birth in Afghanistan.

Science.gov (United States)

Sanghvi, Harshadkumar; Ansari, Nasratullah; Prata, Ndola J V; Gibson, Hannah; Ehsan, Aftab T; Smith, Jeffrey M

2010-03-01

To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan. A nonrandomized experimental control design in rural Afghanistan. A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the intervention group than in the comparison group. Among women in the intervention group, 92% said they would use misoprostol in their next pregnancy. In the intervention area where community-based distribution of misoprostol was introduced, near-universal uterotonic coverage (92%) was achieved compared with 25% coverage in the control areas. In Afghanistan, community-based education and distribution of misoprostol is safe, acceptable, feasible, and effective. This strategy should be considered for other countries where access to skilled attendance is limited.

Community Factors Influencing Birth Spacing among Married ...

African Journals Online (AJOL)

The significance of community-level demographic and fertility norms, gender norms, economic prosperity, and family planning behaviors demonstrate the broad influence of community variables on birth spacing outcomes. This analysis highlights the importance of moving beyond individual and household-level ...

Clinical skill development for community pharmacists.

Science.gov (United States)

Barnette, D J; Murphy, C M; Carter, B L

1996-09-01

The importance of establishing clinical pharmacy services in the community cannot be understated in light of current challenges to the traditional dispensing role as the primary service of the community pharmacist. Advancements in automated dispensing technology and declining prescription fee reimbursement are rapidly forcing pharmacists to seek alternative sources of revenue. Providing pharmaceutical care is a viable option to increase customer loyalty job satisfaction, and reimbursement. To support the development of clinical services, academic institutions are forming partnerships with individual community practitioners to overcome perceived educational and training barriers. The authors describe the design and development of two unique clinical skill development programs at the University of Illinois at Chicago. This paper also outlines the patient focused services that the participants have established upon completing the training. These programs successfully enhanced participants' therapeutic knowledge base and facilitated development of the clinical skills necessary for direct patient care.

Training traditional birth attendants to use misoprostol and an absorbent delivery mat in home births.

Science.gov (United States)

Prata, Ndola; Quaiyum, Md Abdul; Passano, Paige; Bell, Suzanne; Bohl, Daniel D; Hossain, Shahed; Azmi, Ashrafi Jahan; Begum, Mohsina

2012-12-01

A 50-fold disparity in maternal mortality exists between high- and low-income countries, and in most contexts, the single most common cause of maternal death is postpartum hemorrhage (PPH). In Bangladesh, as in many other low-income countries, the majority of deliveries are conducted at home by traditional birth attendants (TBAs) or family members. In the absence of skilled birth attendants, training TBAs in the use of misoprostol and an absorbent delivery mat to measure postpartum blood loss may strengthen the ability of TBAs to manage PPH. These complementary interventions were tested in operations research among 77,337 home births in rural Bangladesh. The purpose of this study was to evaluate TBAs' knowledge acquisition, knowledge retention, and changes in attitudes and practices related to PPH management in home births after undergoing training on the use of misoprostol and the blood collection delivery mat. We conclude that the training was highly effective and that the two interventions were safely and correctly used by TBAs at home births. Data on TBA practices indicate adherence to protocol, and 18 months after the interventions were implemented, TBA knowledge retention remained high. This program strengthens the case for community-based use of misoprostol and warrants consideration of this intervention as a potential model for scale-up in settings where complete coverage of skilled birth attendants (SBAs) remains a distant goal. Copyright © 2012 Elsevier Ltd. All rights reserved.

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Science.gov (United States)

Munabi-Babigumira, Susan; Glenton, Claire; Lewin, Simon; Fretheim, Atle; Nabudere, Harriet

2017-01-01

-income countries. Data collection and analysis One review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review. Main results We included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America. Our synthesis pointed to a number of factors affecting SBAs’ provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always given sufficient training during their education or after they had begun clinical work. Also, inadequate staffing of facilities could increase the workloads of skilled birth attendants, make it difficult to provide supervision and result in mothers being offered poorer care. In addition, SBAs did not always believe that their salaries and benefits reflected their tasks and responsibilities and the personal risks they undertook. Together with poor living and working conditions, these issues were seen to increase stress and to negatively affect family life. Some SBAs also felt that managers lacked capacity and skills, and felt unsupported when their workplace concerns were not addressed. Possible causes of staff shortages in facilities included problems with hiring and assigning health workers to facilities where they were needed; lack of funding; poor management and bureaucratic systems; and low salaries. Skilled

Birth preparedness and complication readiness among pregnant women in Tehulederie district, Northeast Ethiopia: a community-based cross-sectional study.

Science.gov (United States)

Endeshaw, Demlie Belete; Gezie, Lema Derseh; Yeshita, Hedija Yenus

2018-01-01

Motherhood is a time of anticipation of joy for a woman, her family, and her community. In spite of this fact, it is not as enjoyable as it should be because of numerous reasons. Insufficiency or lack of birth preparedness and complication readiness is the most common reason. The aim of this study was to assess the practice of birth preparedness and complication readiness and associated factors among pregnant women in Tehuledere district, northeast Ethiopia. A community-based cross-sectional study was conducted in Tehuledere district, northeast Ethiopia. Participants were selected using the multistage sampling technique, and data were analyzed both descriptively and analytically using the binary logistic regression. Out of the total 507 samples, 500 (response rate 98.6%) pregnant women participated in the study. Less than half (44.6%) and (43.4%) of the respondents had knowledge and practice on birth preparedness and complication readiness, respectively. In the multivariate analysis, knowledge of birth preparedness and complication readiness (AOR = 1.648, 95%CI: 1.073, 2.531), knowledge of danger signs during pregnancy (AOR = 2.802, 95% CI: 1.637, 4.793), gestational age (AOR = 3.379, 95% CI: 2.114, 5.401), and antenatal care follow up starting time (AOR = 2.841, 95% CI: 1.330, 6.068) were significantly associated with the practice of birth preparedness and complication readiness, but pregnant women in rural areas (AOR = 0.442, 95% CI:0.244, 0.803) were less associated with birth preparedness and complication readiness compared to women in urban settlements. This study identified that poor knowledge, inadequate birth preparedness, and complication readiness were prevalent among mothers in the study area. Government officials, partners, and health care providers working in the areas of maternal and child health should operate together to maximize birth preparedness and complication readiness practices.

Adaptation and implementation of family-based treatment enhanced with dialectical behavior therapy skills for anorexia nervosa in community-based specialist clinics.

Science.gov (United States)

Accurso, Erin C; Astrachan-Fletcher, Ellen; O'Brien, Setareh; McClanahan, Susan F; Le Grange, Daniel

2018-01-01

Although family-based therapy (FBT) is a well-established treatment for anorexia nervosa, its implementation and effectiveness in clinical settings has been neglected. A group of seven therapists at a community-based eating disorders clinic were trained in skills-enhanced FBT and provided treatment to 11 youth with anorexia nervosa. Family-based skills training, which borrowed heavily from dialectical behavior therapy, was introduced in four additional sessions and then integrated throughout the remainder of FBT. FBT was perceived as appropriate and acceptable by all participants. Therapists reported high treatment fidelity. There was a large improvement in weight and moderate improvement in caregiver-reported eating disorder psychopathology but no clinically significant change by youth report. This study provides preliminary data on the implementation and effectiveness of FBT in the community.

Employability Skill Acquisition among Malaysian Community College Students

OpenAIRE

M. K. Omar; A. R. Bakar; A. Mat Rashid

2012-01-01

The objective of this study was to assess the acquisition of employability skills among Malaysian community college students. The sample size of the present study 325 students selected randomly. Employability skills were measured using an instrument developed by the Secretaryâs Commission on Achieving Necessary Skills (SCANS). The overall mean of employability skills among community college students was 3.63 (S.D. = 0.47). Thus, we consider the employability skills of community college studen...

Increasing the use of skilled health personnel where traditional birth attendants were providers of childbirth care: a systematic review.

Science.gov (United States)

Vieira, Claudia; Portela, Anayda; Miller, Tina; Coast, Ernestina; Leone, Tiziana; Marston, Cicely

2012-01-01

Improved access to skilled health personnel for childbirth is a priority strategy to improve maternal health. This study investigates interventions to achieve this where traditional birth attendants were providers of childbirth care and asks what has been done and what has worked? We systematically reviewed published and unpublished literature, searching 26 databases and contacting experts to find relevant studies. We included references from all time periods and locations. 132 items from 41 countries met our inclusion criteria and are included in an inventory; six were intervention evaluations of high or moderate quality which we further analysed. Four studies report on interventions to deploy midwives closer to communities: two studies in Indonesia reported an increase in use of skilled health personnel; another Indonesian study showed increased uptake of caesarean sections as midwives per population increased; one study in Bangladesh reported decreased risk of maternal death. Two studies report on interventions to address financial barriers: one in Bangladesh reported an increase in use of skilled health personnel where financial barriers for users were addressed and incentives were given to skilled care providers; another in Peru reported that use of emergency obstetric care increased by subsidies for preventive and maternity care, but not by improved quality of care. The interventions had positive outcomes for relevant maternal health indicators. However, three of the studies evaluate the village midwife programme in Indonesia, which limits the generalizability of conclusions. Most studies report on a main intervention, despite other activities, such as community mobilization or partnerships with traditional birth attendants. Many authors note that multiple factors including distance, transport, family preferences/support also need to be addressed. Case studies of interventions in the inventory illustrate how different countries attempted to address these

High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention.

Science.gov (United States)

Magoma, Moke; Requejo, Jennifer; Campbell, Oona M R; Cousens, Simon; Filippi, Veronique

2010-03-19

In Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated. Twelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed. The Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis. Increasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care Package in Ngorongoro depends upon improved training and monitoring of

Skilled Birth Attendance in Nigeria: A Function of Frequency and ...

African Journals Online (AJOL)

AJRH Managing Editor

The utilization rate of maternal services remains low in sub-Saharan Africa and may ... This study examines the influence of antenatal care (ANC) on skilled birth attendance (SBA) in Nigeria. ... Despite 70% of the women ... poor health outcomes during pregnancy such as .... approximately 50 percent more likely to have had.

Community Context, Land Use and First Birth.

Science.gov (United States)

Ghimire, Dirgha J; Axinn, William G

2010-09-01

This paper examines the influence of community context and land use on the monthly odds of first birth in a society in the midst of dramatic fertility transition. The theoretical framework guiding our work predicts that proximity to non-family services should delay first births by creating opportunities for competing non-family activities and spreading new ideas that change expectations about family life. On the other hand, living in agricultural settings that provide opportunities for higher returns to the child labor should speed first births. We use a longitudinal, multilevel, mixed-method data from the Nepalese Himalayas to test these predictions. The empirical results reveal that non-family services during childhood and during early adulthood both have important independent influences on the odds of first birth. Also, as predicted, a high density of agricultural land use affects the odds of first births in the opposite direction, speeding first births. This clear pattern of contrasting effects provides important new evidence of the contextual dynamics that produce watershed changes in post-marital birth timing.

Helping Mothers Survive Bleeding After Birth: retention of knowledge, skills, and confidence nine months after obstetric simulation-based training.

Science.gov (United States)

Nelissen, Ellen; Ersdal, Hege; Mduma, Estomih; Evjen-Olsen, Bjørg; Broerse, Jacqueline; van Roosmalen, Jos; Stekelenburg, Jelle

2015-08-25

It is important to know the decay of knowledge, skills, and confidence over time to provide evidence-based guidance on timing of follow-up training. Studies addressing retention of simulation-based education reveal mixed results. The aim of this study was to measure the level of knowledge, skills, and confidence before, immediately after, and nine months after simulation-based training in obstetric care in order to understand the impact of training on these components. An educational intervention study was carried out in 2012 in a rural referral hospital in Northern Tanzania. Eighty-nine healthcare workers of different cadres were trained in "Helping Mothers Survive Bleeding After Birth", which addresses basic delivery skills including active management of third stage of labour and management of postpartum haemorrhage (PPH). Knowledge, skills, and confidence were tested before, immediately after, and nine months after training amongst 38 healthcare workers. Knowledge was tested by completing a written 26-item multiple-choice questionnaire. Skills were tested in two simulated scenarios "basic delivery" and "management of PPH". Confidence in active management of third stage of labour, management of PPH, determination of completeness of the placenta, bimanual uterine compression, and accessing advanced care was self-assessed using a written 5-item questionnaire. Mean knowledge scores increased immediately after training from 70 % to 77 %, but decreased close to pre-training levels (72 %) at nine-month follow-up (p = 0.386) (all p-levels are compared to pre-training). The mean score in basic delivery skills increased after training from 43 % to 51 %, and was 49 % after nine months (p = 0.165). Mean scores of management of PPH increased from 39 % to 51 % and were sustained at 50 % at nine months (p = 0.003). Bimanual uterine compression skills increased from 19 % before, to 43 % immediately after, to 48 % nine months after training (p = 0

Teaching Advanced Leadership Skills in Community Service (ALSCS) to medical students.

Science.gov (United States)

Goldstein, Adam O; Calleson, Diane; Bearman, Rachel; Steiner, Beat D; Frasier, Pamela Y; Slatt, Lisa

2009-06-01

Inadequate access to health care, lack of health insurance, and significant health disparities reflect crises in health care affecting all of society. Training U.S. physicians to possess not only clinical expertise but also sufficient leadership skills is essential to solve these problems and to effectively improve health care systems. Few models in the undergraduate medical curriculum exist for teaching students how to combine needed leadership competencies with actual service opportunities.The Advanced Leadership Skills in Community Service (ALSCS) selective developed in response to the shortage of leadership models and leadership training for medical students. The ALSCS selective is designed specifically to increase students' leadership skills, with an emphasis on community service. The selective integrates classroom-based learning, hands-on application of learned skills, and service learning. More than 60 medical students have participated in the selective since inception. Short-term outcomes demonstrate an increase in students' self-efficacy around multiple dimensions of leadership skills (e.g., fundraising, networking, motivating others). Students have also successfully completed more than a dozen leadership and community service projects. The selective offers an innovative model of a leadership-skills-based course that can have a positive impact on leadership skill development among medical school students and that can be incorporated into the medical school curriculum.

Women's social networks and use of facility delivery services for uncomplicated births in North West Ethiopia: a community-based case-control study.

Science.gov (United States)

Asrese, Kerebih; Adamek, Margaret E

2017-12-28

High maternal mortality has remained an unmet public health challenge in the developing world. Maternal mortality in Ethiopia is among the highest in the world. Since most maternal deaths occur during labor, delivery, and the immediate postpartum period, facility delivery with skilled birth attendants is recommended to reduce maternal mortality. Nonetheless, the majority of women in Ethiopia give birth at home. Individual attributes and availability and accessibility of services deter service utilization. The role of social networks that may facilitate or constrain service use is not well studied. Community-based case-control study was conducted between February and March 2014 in Jabi Tehinan District, North West Ethiopia. Retrospective data were collected from 134 women who had uncomplicated births at health facilities and 140 women who had uncomplicated births at home within a year preceding the survey. Interviews were held with eight women who had uncomplicated births at health facilities and 11 who had uncomplicated births at home. The quantitative data were entered and analyzed using SPSS for Windows versions 16.0 and hierarchical logistic regression model was used for analysis. The qualitative data were transcribed verbatim and data were used to substantiate the quantitative data. The results indicated that social network variables were significantly associated with the use of health facilities for delivery. Taking social networks into account improved the explanation of facility use for delivery services over women's individual attributes. Women embedded within homogeneous network members (Adjusted OR 2.53; 95% CI: 1.26-5.06) and embedded within high SBA endorsement networks (Adjusted OR 7.97; 95% CI: 4.07-12.16) were more likely to deliver at health facilities than their counterparts. Women living in urban areas (Adjusted OR 3.32; 95% CI: 1.37-8.05) and had better knowledge of obstetric complications (Adjusted OR 3.01; 95% CI: 1.46-6.18) were more likely to

Pregnancy and Village Outreach Tibet: a descriptive report of a community- and home-based maternal-newborn outreach program in rural Tibet.

Science.gov (United States)

Dickerson, Ty; Crookston, Benjamin; Simonsen, Sara E; Sheng, Xiaoming; Samen, Arlene; Nkoy, Flory

2010-01-01

The Pregnancy and Village Outreach Tibet (PAVOT) program, a model for community- and home-based maternal-newborn outreach in rural Tibet, is presented. This article describes PAVOT, including the history, structure, content, and activities of the program, as well as selected program outcome measures and demographic characteristics, health behaviors, and pregnancy outcomes of women who recently participated in the program. The PAVOT program was developed to provide health-related services to pregnant rural Tibetan women at risk of having an unattended home birth. The program involves training local healthcare workers and laypersons to outreach pregnant women and family members. Outreach includes basic maternal-newborn health education and simple obstetric and neonatal life-saving skills training. In addition, the program distributes safe and clean birth kits, newborn hats, blankets, and maternal micronutrient supplements (eg, prenatal vitamins and minerals). More than 980 pregnant women received outreach during the study period. More than 92% of outreach recipients reported receiving safe pregnancy and birth education, clean birthing and uterine massage skills instruction, and clean umbilical cord care training. Nearly 80% reported basic newborn resuscitation skills training. Finally, nearly 100% of outreach recipients received maternal micronutrient supplements and safe and clean birth kits. The PAVOT program is a model program that has been proven to successfully provide outreach to rural-living Tibetans by delivering maternal-newborn health education, skills training, and resources to the home.

Effect of an innovative community based health program on maternal health service utilization in north and south central Ethiopia: a community based cross sectional study.

Science.gov (United States)

Afework, Mesganaw Fantahun; Admassu, Kesteberhan; Mekonnen, Alemayehu; Hagos, Seifu; Asegid, Meselech; Ahmed, Saifuddin

2014-04-04

Among Millennium Development Goals, achieving the fifth goal (MDG-5) of reducing maternal mortality poses the greatest challenge in Sub-Saharan Africa. Ethiopia has one of the highest maternal mortality ratios in the world with unacceptably low maternal health service utilization. The Government of Ethiopia introduced an innovative community-based intervention as a national strategy under the Health Sector Development Program. This new approach, known as the Health Extension Program, aims to improve access to and equity in essential health services through community based Health Extension Workers. The objective of the study is to assess the role of Health Extension Workers in improving women's utilization of antenatal care, delivery at health facility and postnatal care services. A cross sectional household survey was conducted in early 2012 in two districts of northern and south central parts of Ethiopia. Data were collected from 4949 women who had delivered in the two years preceding the survey. Logistic regression analysis was performed to determine the association between visit by Health Extension Workers during pregnancy and use of maternal health services, controlling for the effect of other confounding factors. The non-adjusted analysis showed that antenatal care attendance at least four times during pregnancy was significantly associated with visit by Health Extension Workers [Odds Ratio 3.46(95% CI 3.07,3.91)], whereas health facility delivery (skilled attendance at birth) was not significantly associated with visit by Health Extension Workers during pregnancy [Odds Ratio 0.87(95% CI 0.25,2.96)]. When adjusted for other factors the association of HEWs visit during pregnancy was weaker for antenatal care attendance [Adjusted Odds Ratio: 1.35(95% CI: 1.05, 1.72)] but positively and significantly associated with health facility delivery [Adjusted Odds Ratio 1.96(1.25,3.06)]. In general HEWs visit during pregnancy improved utilization of maternal health

A regional multilevel analysis: can skilled birth attendants uniformly decrease neonatal mortality?

Science.gov (United States)

Singh, Kavita; Brodish, Paul; Suchindran, Chirayath

2014-01-01

Globally 40 % of deaths to children under-five occur in the very first month of life with three-quarters of these deaths occurring during the first week of life. The promotion of delivery with a skilled birth attendant (SBA) is being promoted as a strategy to reduce neonatal mortality. This study explored whether SBAs had a protective effect against neonatal mortality in three different regions of the world. The analysis pooled data from nine diverse countries for which recent Demographic and Health Survey data were available. Multilevel logistic regression was used to understand the influence of skilled delivery on two outcomes-neonatal mortality during the first week of life and during the first day of life. Control variables included age, parity, education, wealth, residence (urban/rural), geographic region (Africa, Asia and Latin America/Caribbean), antenatal care and tetanus immunization. The direction of the effect of skilled delivery on neonatal mortality was dependent on geographic region. While having a SBA at delivery was protective against neonatal mortality in Latin America/Caribbean, in Asia there was only a protective effect for births in the first week of life. In Africa SBAs were associated with higher neonatal mortality for both outcomes, and the same was true for deaths on the first day of life in Asia. Many women in Africa and Asia deliver at home unless a complication occurs, and thus skilled birth attendants may be seeing more women with complications than their unskilled counterparts. In addition there are issues with the definition of a SBA with many attendants in both Africa and Asia not actually having the needed training and equipment to prevent neonatal mortality. Considerable investment is needed in terms of training and health infrastructure to enable these providers to save the youngest lives.

Reducing one million child deaths from birth asphyxia – a survey of health systems gaps and priorities

Directory of Open Access Journals (Sweden)

Manandhar Ananta

2007-05-01

Full Text Available Abstract Background Millions of child deaths and stillbirths are attributable to birth asphyxia, yet limited information is available to guide policy and practice, particularly at the community level. We surveyed selected policymakers, programme implementers and researchers to compile insights on policies, programmes, and research to reduce asphyxia-related deaths. Method A questionnaire was developed and pretested based on an extensive literature review, then sent by email (or airmail or fax, when necessary to 453 policymakers, programme implementers, and researchers active in child health, particularly at the community level. The survey was available in French and English and employed 5-point scales for respondents to rate effectiveness and feasibility of interventions and indicators. Open-ended questions permitted respondents to furnish additional details based on their experience. Significance testing was carried out using chi-square, F-test and Fisher's exact probability tests as appropriate. Results 173 individuals from 32 countries responded (44%. National newborn survival policies were reported to exist in 20 of 27 (74% developing countries represented, but respondents' answers were occasionally contradictory and revealed uncertainty about policy content, which may hinder policy implementation. Respondents emphasized confusing terminology and a lack of valid measurement indicators at community level as barriers to obtaining accurate data for decision making. Regarding interventions, birth preparedness and essential newborn care were considered both effective and feasible, while resuscitation at community level was considered less feasible. Respondents emphasized health systems strengthening for both supply and demand factors as programme priorities, particularly ensuring wide availability of skilled birth attendants, promotion of birth preparedness, and promotion of essential newborn care. Research priorities included operationalising

High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention

Directory of Open Access Journals (Sweden)

Cousens Simon

2010-03-01

Full Text Available Abstract Background In Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated. Methods Twelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed. Results The Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis. Conclusions Increasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care

Reading, Mathematics and Fine Motor Skills at 5 Years of Age in US Children who were Extremely Premature at Birth.

Science.gov (United States)

Lee, Miryoung; Pascoe, John M; McNicholas, Caroline I

2017-01-01

Objectives The prevalence of extreme prematurity at birth has increased, but little research has examined its impact on developmental outcomes in large representative samples within the United States. This study examined the association of extreme prematurity with kindergarteners' reading skills, mathematics skills and fine motor skills. Methods The early childhood longitudinal study-birth cohort, a representative sample of the US children born in 2001 was analyzed for this study. Early reading and mathematics skills and fine motor skills were compared among 200 extremely premature children (EPC) (gestational age motor performance of PC (failed to build a gate, 1.3[95 % CI 1.0-1.7]; failed to draw all four shapes, 1.1[95 % CI 0.8-1.6]) was not significantly different from TC. Mean early reading scale score (36.8[SE:1.3]) of EPC was 4.0 points lower than TC (p value motor delays at age 5 years. This suggests that based on a nationally representative sample of infants, the biological risk of extreme prematurity persists after adjusting for other factors related to development.

Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, north west of Ethiopia: a community-based cross sectional study.

Science.gov (United States)

Teferra, Alemayehu Shimeka; Alemu, Fekadu Mazengia; Woldeyohannes, Solomon Meseret

2012-07-31

Reduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia. Community-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software. The study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%), home delivery is usual practice (57.7%), unexpected labour (33.4%), not being sick or no problem at the time of delivery (21.6%) and family influence (14.4%). Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9]), ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4]), maternal education level (AOR [95%CI] =11.98 [3.36, 41.4]) and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6]) had significant associations with institutional delivery service utilization. Very low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of knowledge on pregnancy and delivery services were found to

Preterm Birth and Adult Wealth: Mathematics Skills Count.

Science.gov (United States)

Basten, Maartje; Jaekel, Julia; Johnson, Samantha; Gilmore, Camilla; Wolke, Dieter

2015-10-01

Each year, 15 million babies worldwide are born preterm. Preterm birth is associated with adverse neurodevelopmental outcomes across the life span. Recent registry-based studies suggest that preterm birth is associated with decreased wealth in adulthood, but the mediating mechanisms are unknown. This study investigated whether the relationship between preterm birth and low adult wealth is mediated by poor academic abilities and educational qualifications. Participants were members of two British population-based birth cohorts born in 1958 and 1970, respectively. Results showed that preterm birth was associated with decreased wealth at 42 years of age. This association was mediated by decreased intelligence, reading, and, in particular, mathematics attainment in middle childhood, as well as decreased educational qualifications in young adulthood. Findings were similar in both cohorts, which suggests that these mechanisms may be time invariant. Special educational support in childhood may prevent preterm children from becoming less wealthy as adults. © The Author(s) 2015.

Can community-based, low-cost antenatal care in the third trimester of pregnancy reduce the incidence of low birth weight newborns?

Science.gov (United States)

Chaudhary, A K; Chaudhary, Asha; Tiwari, S C; Dwivedi, R

2012-06-01

To determine if community-based, low-cost interventions during third trimester of pregnancy can reduce the incidence of low birth weight babies. In a case control study, 290 pregnant women from a slum area were registered in the beginning of third trimester of pregnancy and provided full antenatal care comprising fortnightly check up, one IFA tablet daily, counseling for minimum one-and-a-half hour post-lunch rest in left lateral position, additional diet to ensure minimum 2,200 kcal per day, and management of clinical conditions, if any. An equal number of pregnant women belonging to the same slum area were registered as control who received routine antenatal services from the existing health care facilities. The birth weight of the babies in the two groups were recorded and compared. Test of significance and correlation coefficient were applied to the data. Mean birth weight of the babies of the Subjects was 2.76 kg (SD 0.39) compared to mean birth weight of 2.57 kg (SD 0.36) of the babies in the Control group. Incidence of low birth weight babies among subjects who consumed minimum 2,400 kcal per day, had one-and-a-half hour post-lunch rest in left lateral position and who consumed one tablet of IFA (100 mg iron and 5 mg folic acid) per day during the last trimester of pregnancy was lower (17.6 %) as compared with women in the Control group (36.2 %). The difference in the mean birth weight of newborns of the two groups was statistically significant (t = 2.52, p < 0.01). Incidence of low birth weight babies can be significantly reduced by providing simple, low-cost care to pregnant women during the last trimester of pregnancy in the community setting.

Preventing adolescent pregnancy with social and cognitive skills.

Science.gov (United States)

Barth, R P; Fetro, J V; Leland, N; Volkan, K

1992-04-01

A 15-session sex education program was delivered by teachers to 586 10th graders using techniques based on social learning theory, including modeling, in-class and out-of-class practice of skills for abstaining from sexual intercourse, and for contraception. Knowledge about reproduction and birth control, intentions to use skills to avoid pregnancy, and communication with parents about pregnancy prevention were significantly greater at posttest and 6-month follow-up for the trained group than for the control group. Members of the trained group tended to use birth control more often, especially those who started to have sexual intercourse subsequent to the program. No differences in the frequency of sexual intercourse, pregnancy scares, or pregnancies were found. Satisfaction with the program was high. Although skill training by itself may not be sufficient to significantly prevent pregnancies, this program offers promise of being a useful component of combined school, home, and community activities to prevent pregnancy.

Intermittent preventive treatment of malaria in pregnancy: a community-based delivery system and its effect on parasitemia, anemia and low birth weight in Uganda

DEFF Research Database (Denmark)

Mbonye, Anthony K; Bygbjerg, Ib; Magnussen, Pascal

2008-01-01

OBJECTIVE: The main objective of the study was to assess the impact of a community-based delivery system of intermittent preventive treatment (IPT) for malaria in pregnancy with sulfadoxine-pyrimethamine (SP) on access, parasitemia, anemia and low birth weight as primary outcome measures. METHODS.......0001). At both health units and the community-based approaches, IPT increased mean hemoglobin by 6.7% (panemia from 5.7% to 3.1% (p.... This intervention was acceptable to 89.6% of the women at the community-based approaches intending to use IPT in the future, while 48.1% of them had recommended it to other women. CONCLUSIONS: The community-based approaches increased access and adherence to IPT with an effect on anemia, severe anemia, parasitemia...

Teaching Independent Community Social Skills to the Multihandicapped.

Science.gov (United States)

Beaulac, Pauline F.

Ten multihandicapped high-school students in the Dayton (Ohio) Public Schools were trained using a curriculum of independent community social skills, focusing specifically on restaurant skills, travel skills, shopping skills, self-care skills, and skills for visiting a business or government agency. The students made weekly trips into the…

Deliberate acquisition of competence in physiological breech birth: A grounded theory study.

Science.gov (United States)

Walker, Shawn; Scamell, Mandie; Parker, Pam

2018-06-01

Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems. Due to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear. How do professionals develop competence and expertise in physiological breech birth? Nine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition. Among the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners. The results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices. Deliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Identification of Essential Food Skills for Skill-Based Healthful Eating Programs in Secondary Schools

Science.gov (United States)

Fordyce-Voorham, Sandra

2011-01-01

Objective: To identify the food skills deemed essential to include in skill-based healthful eating programs in secondary schools. Methods: Fifty-one food experts including home economics educators, chefs, nutritionists and dietitians, community educators, homemakers, and young people were recruited by invitation, mail, and advertising. Data were…

IMPROVING THE HARD SKILLS AND SOFT SKILLS OF MADRASAH TEACHERS FOR DEALING ASEAN ECONOMIC COMMUNITY (AEC)

OpenAIRE

Laely Mahmudah

2016-01-01

ASEAN Economic Community (AEC) has been started rolling. Market competition, industry, and skilled workers, especially in the field of education are becoming increasingly stringent. Madrasah teachers as the front liners in the education process should improve the quality of human resources. Hard skills and soft skills of madrasah teachers must be improved to deal with the Asean Economic Community (AEC). Hard skills are academic skills that include pedagogic competence and professional compete...

Improving The Hard Skills And Soft Skills Of Madrasah Teachers For Dealing ASEAN Economic Community (Aec)

OpenAIRE

Mahmudah, Laely

2016-01-01

ASEAN Economic Community (AEC) has been started rolling. Market competition, industry, and skilled workers, especially in the field of education are becoming increasingly stringent. Madrasah teachers as the front liners in the education process should improve the quality of human resources. Hard skills and soft skills of madrasah teachers must be improved to deal with the Asean Economic Community (AEC). Hard skills are academic skills that include pedagogic competence and professional compete...

Community-based stillbirth rates and risk factors in rural Sarlahi, Nepal.

Science.gov (United States)

Lee, Anne C; Mullany, Luke C; Tielsch, James M; Katz, Joanne; Khatry, Subarna K; Leclerq, Steven C; Adhikari, Ramesh K; Darmstadt, Gary L

2011-06-01

To assess stillbirth rates and antepartum risk factors in rural Nepal. Data were collected prospectively during a cluster-randomized, community-based trial in Sarlahi, Nepal, from 2002 to 2006. Multivariate regression modeling was performed to calculate adjusted relative risk estimates. Among 24531 births, the stillbirth rate was 35.4 per 1000 births (term stillbirth rate 21.2 per 1000 births). Most births occurred at home without a skilled birth attendant. The majority (69%) of intrapartum maternal deaths resulted in stillbirth. The adjusted RR (aRR) of stillbirth was 2.74 among nulliparas and 1.47 among mothers with history of a child death. Mothers above the age of 30 years carried a 1.59-fold higher risk for stillbirth than mothers who were 20-24 years old. The stillbirth risk was lower among households where the father had any formal education (aRR 0.70). Land ownership (aRR 0.85) and Pahadi ethnicity (aRR 0.67; reference: Madhesi ethnicity) were associated with significantly lower risks of stillbirth. Stillbirth rates were high in rural Nepal, with the majority of stillbirths occurring at full-term gestation. Nulliparity, history of prior child loss, maternal age above 30 years, Madhesi ethnicity, and socioeconomic disadvantage were significant risk factors for stillbirth. Clinicaltrials.govNCT00 109616. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Skilled delivery care service utilization in Ethiopia: analysis of rural-urban differentials based on national demographic and health survey (DHS) data.

Science.gov (United States)

Fekadu, Melaku; Regassa, Nigatu

2014-12-01

Despite the slight progress made on Antenatal Care (ANC) utilization, skilled delivery care service utilization in Ethiopia is still far-below any acceptable standards. Only 10% of women receive assistance from skilled birth attendants either at home or at health institutions, and as a result the country is recording a high maternal mortality ratio (MMR) of 676 per 100,000 live births (EDHS, 2011). Hence, this study aimed at identifying the rural-urban differentials in the predictors of skilled delivery care service utilization in Ethiopia. The study used the recent Ethiopian Demographic and Health Survey (EDHS 2011) data. Women who had at least one birth in the five years preceding the survey were included in this study. The data were analyzed using univariate (percentage), bivariate (chi-square) and multivariate (Bayesian logistic regression). The results showed that of the total 6,641 women, only 15.6% received skilled delivery care services either at home or at health institution. Rural women were at greater disadvantage to receive the service. Only 4.5% women in rural areas received assistance from skilled birth attendants (SBAs) compared to 64.1 % of their urban counter parts. Through Bayesian logistic regression analysis, place of residence, ANC utilization, women's education, age and birth order were identified as key predictors of service utilization. The findings highlight the need for coordinated effort from government and stakeholders to improve women's education, as well as strengthen community participation. Furthermore, the study recommended the need to scale up the quality of ANC and family planning services backed by improved and equitable access, availability and quality of skilled delivery care services.

Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: A community - based cross sectional study

Directory of Open Access Journals (Sweden)

Teferra Alemayehu

2012-07-01

Full Text Available Abstract Background Reduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia. Methods Community-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software. Results The study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%, home delivery is usual practice (57.7%, unexpected labour (33.4%, not being sick or no problem at the time of delivery (21.6% and family influence (14.4%. Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9], ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4], maternal education level (AOR [95%CI] =11.98 [3.36, 41.4] and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6] had significant associations with institutional delivery service utilization. Conclusions Very low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of

Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study.

Directory of Open Access Journals (Sweden)

Resham Bahadur Khatri

Full Text Available Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers.We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis.Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center.The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.

Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study.

Science.gov (United States)

Khatri, Resham Bahadur; Dangi, Tara Prasad; Gautam, Rupesh; Shrestha, Khadka Narayan; Homer, Caroline S E

2017-01-01

Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.

Safe delivery care practices in western Nepal: Does women's autonomy influence the utilization of skilled care at birth?

Science.gov (United States)

Bhandari, Tulsi Ram; Kutty, V Raman; Sarma, P Sankara; Dangal, Ganesh

2017-01-01

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives-women's autonomy-plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women's autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women's autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women's education had a strong positive association (odds ratio = 24.11, CI = 9.43-61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women's education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband's education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women's autonomy may be an important mediating factor in this pathway.

Knowledge, attitudes and practices of traditional birth attendants in pastoralist communities of Laikipia and Samburu counties, Kenya: a cross-sectional survey.

Science.gov (United States)

Reeve, Matthew; Onyo, Pamela; Nyagero, Josephat; Morgan, Alison; Nduba, John; Kermode, Michelle

2016-01-01

Current efforts to reduce maternal and newborn mortality focus on promoting institutional deliveries with skilled birth attendants (SBAs), and discouraging deliveries at home attended by traditional birth attendants (TBAs). In rural Kenya, semi-nomadic pastoralist communities are underserved by the formal health system, experience high maternal and neonatal mortality, and rely primarily on TBAs for delivery care, despite Government proscription of TBA-assisted births. This study examined the knowledge, attitude and practices of TBAs serving these communities to assess the potential for collaboration between TBAs and SBAs. A cross-sectional, interviewer-administered survey was conducted among 171 TBAs from Maasai and Samburu pastoralist communities in Laikipia and Samburu counties, Kenya, as part of a larger mixed-methods study in partnership with a local service provider. BAs were relatively elderly (mean age 59.6 years), and attended an average of 5-6 deliveries per year. A minority (22.2%) had received formal training. They provided antenatal, intra-partum and post-partum care. Most TBA care was non-interventionist, but not necessarily consistent with best practice. Most had encountered birth complications, but knowledge regarding management of complications was sub-optimal. Most had previously referred at least one woman to a health facility (80.1%), were key participants in decision making to refer women (96.5%), and had been present at an institutional delivery (54.4%). TBAs continue to be key providers of maternal and neonatal healthcare in regions where the formal health system has poor coverage or acceptability. Strengthening existing TBA/SBA collaborations could improve both community links to the formal health system, and the quality of care provided to pastoralist women, while remaining consistent with current Government policy.

What influences the decision to undergo institutional delivery by skilled birth attendants? A cohort study in rural Andhra Pradesh, India.

Science.gov (United States)

Nair, M; Ariana, P; Webster, P

2012-01-01

Despite continuing efforts to promote skilled institutional delivery, eight women die every hour in India due to causes related to pregnancy and child birth. The objectives of this study were to assess the prevalence and the determinants of institutional delivery by skilled birth attendants in a rural population in Andhra Pradesh, India. This cross-sectional study used data from 'Young Lives', a longitudinal study on childhood poverty, and the study population was a cohort of 1419 rural, economically deprived women (from the Young Lives study) in Andhra Pradesh, India. The data are from round-1 of Young Lives younger cohort recruited in 2002 and followed until 2015. The participation rate of households was 99.5%. Prevalence of skilled institutional delivery was 36.8%. Women's education (odds ratio [OR] for secondary education 2.06; 95% confidence interval [95%CI] 1.33-3.19), desire to be pregnant (OR 1.89; 95% CI 1.12-3.22) and adequate prenatal care (OR 1.69; 95% CI 1.30-2.21) were found to be the positive determinants of skilled institutional delivery. High birth order (OR for second birth 0.44; 95% CI 0.32-0.60, OR for third birth 0.47; 95% CI 0.30-0.72 and OR for ≥fourth 0.47; 95% CI 0.27-0.81), schedule caste/schedule tribe social background (OR 0.70; 95% CI 0.53-0.93) and poor economic status of the household (OR for the poorest households 0.67; 95% CI 0.46-0.99) were negatively associated with skilled institutional delivery. Despite existence of supporting schemes, the utilisation of skilled institutional delivery services was low in the study population. Educated women and women with adequate prenatal care who have a desired pregnancy were more likely to utilise health institutions and skilled delivery care. There is a need for integrated approaches through maternal health, family planning and education programs, and a focus on uneducated, poor women belonging to disadvantaged social groups.

Socioeconomic determinants of accessibility to birth registration in Lao PDR.

Science.gov (United States)

Nomura, Marika; Xangsayarath, Phonepadith; Takahashi, Kenzo; Kamiya, Yusuke; Siengsounthone, Latsamy; Ogino, Hina; Kobayashi, Jun

2018-01-08

The global coverage rate of birth registration is only around 65% for the population of children under five although birth registration secures protection and access to health services that are fundamental rights for all babies. This study aimed to perform a basic analysis of the accessibility to birth registration to better understand how to improve the birth registration system in the Lao PDR. For the analysis of birth registration and related socioeconomic factors, 9576 mother-child pairs were chosen from the data set of The Lao Social Indicator Survey 2011-12. After bivariate analysis with statistical tests including the chi-square test were conducted, logistic regression was performed to determine the variables that statistically influence accessibility to birth registration. Ethno-geographic factors and place of delivery were observed to be the factors associated with birth registration in this analysis. Many mothers in the Lao PDR deliver in their local communities. Therefore, capacity development of various human resources, such as Skilled Birth Attendant, to support the local administrative procedure of birth registration in their communities could be one option to overcoming the bottlenecks in the birth registration process in the Lao PDR.

Research participants' skills development as HIV prevention peer educators in their communities.

Science.gov (United States)

Morar, Neetha Shagan; Naidoo, Sarita; Goolam, Ahmed; Ramjee, Gita

2016-06-01

This article describes the influence of a peer education programme on skills development among 22 women participating in HIV prevention trials. Interviews were used to collect data on peer educator experiences and their opinions of the trainings. The training enhanced their agency and confidence to engage their family and community on health promotion, including HIV prevention research procedures, thus improving their self-esteem and communication skills. Training and partnering with clinical trial participants as peer educators is an effective and sustainable community-based approach for HIV prevention.

Community pharmacists in England's opinions on skill mix and delegation.

Science.gov (United States)

Barnes, Emma; Bullock, Alison; Allan, Margaret; Hodson, Karen

2017-12-06

Following the 2005 contractual framework amendment, the expanding role of community pharmacy team members required a shift in entrenched views on roles and duties. This study aimed to report on community pharmacists' opinions on skill mix and explore how they can be addressed so that skill mix may be optimised. An invitation to complete an online questionnaire was distributed via email, marked for the attention of the lead pharmacist. Following a low response, a paper-based questionnaire was sent to all community pharmacies in England (n = 11,816). Questions elicited data about the respondent, the pharmacy (including staffing profile) and opinions on skill mix. A total of 1154 returns were received, representing a 10% response rate. Of these, most were pharmacy chains (76%; n = 877), with 5-9 staff (54%; n = 600); commonly open 40-49 hours (42%; n = 487), dispensing <6000 prescriptions per week (41%, n = 533). From 26 statements on skill mix, three factors were identified by principal-components factor analysis: 'working well', 'feeling the pressure' and 'open to development'. Characteristics associated with 'working well': pharmacy owners, single businesses, with pharmacy technician(s), dispensing fewer prescriptions and open shorter hours. Characteristics associated with 'feeling the pressure': pharmacy chains, open longer hours, large numbers of prescriptions and relief pharmacists. Characteristics associated with 'open to development': recently qualified, second pharmacists, working longer hours, chains and dispensing lower numbers of prescriptions. Although limited by a low response, results suggest being in a position to influence (more experienced, business owners) may be associated with more positive opinions. Further training (including about legalities and leadership) could contribute to optimising skill mix in community pharmacies. © 2017 Royal Pharmaceutical Society.

Measuring the Impacts of a Volunteer-Based Community Development Program in Developing Volunteers' Leadership Skills

Science.gov (United States)

Meier, Amy; Singletary, Loretta; Hill, George

2012-01-01

This article summarizes the results of an evaluation of the impacts of a community development program to develop leadership skills in its adult volunteers. The evaluation featured 20 questions about leadership skills learned as a result of volunteer experiences. Data analysis strategies beyond a simple means ranking resulted in evidence…

Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study

Science.gov (United States)

Shrestha, Khadka Narayan; Homer, Caroline S. E.

2017-01-01

Background Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. Methods We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. Results Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. Conclusion The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries. PMID:28493987

Primary birthing attendants and birth outcomes in remote Inuit communities—a natural “experiment” in Nunavik, Canada

Science.gov (United States)

Simonet, F; Wilkins, R; Labranche, E; Smylie, J; Heaman, M; Martens, P; Fraser, W D; Minich, K; Wu, Y; Carry, C; Luo, Z-C

2010-01-01

Background There is a lack of data on the safety of midwife-led maternity care in remote or indigenous communities. In a de facto natural “experiment”, birth outcomes were assessed by primary birthing attendant in two sets of remote Inuit communities. Methods A geocoding-based retrospective birth cohort study in 14 Inuit communities of Nunavik, Canada, 1989–2000: primary birth attendants were Inuit midwives in the Hudson Bay (1529 Inuit births) vs western physicians in Ungava Bay communities (1197 Inuit births). The primary outcome was perinatal death. Secondary outcomes included stillbirth, neonatal death, post-neonatal death, preterm, small-for-gestational-age and low birthweight birth. Multilevel logistic regression was used to obtain the adjusted odds ratios (aOR) controlling for maternal age, marital status, parity, education, infant sex and plurality, community size and community-level random effects. Results The aORs (95% confidence interval) for perinatal death comparing the Hudson Bay vs Ungava Bay communities were 1.29 (0.63 to 2.64) for all Inuit births and 1.13 (0.48 to 2.47) for Inuit births at ≥28 weeks of gestation. There were no statistically significant differences in the crude or adjusted risks of any of the outcomes examined. Conclusion Risks of perinatal death were somewhat but not significantly higher in the Hudson Bay communities with midwife-led maternity care compared with the Ungava Bay communities with physician-led maternity care. These findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote indigenous communities. PMID:19286689

A cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to increase the utilization of skilled birth attendants by women for childbirth: study protocol.

Science.gov (United States)

Bhandari, Gajananda P; Subedi, Narayan; Thapa, Janak; Choulagai, Bishnu; Maskey, Mahesh K; Onta, Sharad R

2014-03-19

Nepal is on track to achieve MDG 5 but there is a huge sub-national disparity with existing high maternal mortality in western and hilly regions. The national priority is to reduce this disparity to achieve the goal at sub-national level. Evidences from developing countries show that increasing utilization of skilled attendant at birth is an important indicator for reducing maternal death. Further, there is a very low utilization during childbirth in western and hilly regions of Nepal which clearly depicts the barriers in utilization of skilled birth attendants. So, there is a need to overcome the identified barriers to increase the utilization thereby decreasing the maternal mortality. The hypothesis of this study is that through a package of interventions the utilization of skilled birth attendants will be increased and hence improve maternal health in Nepal. This study involves a cluster randomized controlled trial involving approximately 5000 pregnant women in 36 clusters. The 18 intervention clusters will receive the following interventions: i) mobilization of family support for pregnant women to reach the health facility, ii) availability of emergency funds for institutional childbirth, iii) availability of transport options to reach a health facility for childbirth, iv) training to health workers on communication skills, v) security provisions for SBAs to reach services 24/24 through community mobilization; 18 control clusters will not receive the intervention package. The final evaluation of the intervention is planned to be completed by October 2014. Primary study output of this study is utilization of SBA services. Secondary study outputs measure the uptake of antenatal care, post natal checkup for mother and baby, availability of transportation for childbirth, operation of emergency fund, improved reception of women at health services, and improved physical security of SBAs. The intervention package is designed to increase the utilization of skilled

Birth environment facilitation by midwives assisting in non-hospital births: a qualitative interview study.

Science.gov (United States)

Igarashi, Toshiko; Wakita, Mariko; Miyazaki, Kikuko; Nakayama, Takeo

2014-07-01

midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved. semi-structured qualitative interview study and constant comparative analysis. 14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births. Osaka, Kyoto, Nara, and Shiga, Japan. midwives assisting at non-hospital births organised the birth environment based on the following four categories: 'an environment where the mother and family are autonomous'; 'a physical environment that facilitates birth'; 'an environment that facilitates the movement of the mother for birth'; and 'scrupulous safety preparation'. These, along with their sub-categories, are presented in this paper. independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research. Copyright © 2014 Elsevier Ltd. All rights reserved.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

OpenAIRE

Sharad Onta; Bishnu Choulagai; Binjwala Shrestha; Narayan Subedi; Gajananda P. Bhandari; Alexandra Krettek

2014-01-01

Background: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care.Design: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the...

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis.

Science.gov (United States)

Munabi-Babigumira, Susan; Glenton, Claire; Lewin, Simon; Fretheim, Atle; Nabudere, Harriet

2017-11-17

assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review. We included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America.Our synthesis pointed to a number of factors affecting SBAs' provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always given sufficient training during their education or after they had begun clinical work. Also, inadequate staffing of facilities could increase the workloads of skilled birth attendants, make it difficult to provide supervision and result in mothers being offered poorer care. In addition, SBAs did not always believe that their salaries and benefits reflected their tasks and responsibilities and the personal risks they undertook. Together with poor living and working conditions, these issues were seen to increase stress and to negatively affect family life. Some SBAs also felt that managers lacked capacity and skills, and felt unsupported when their workplace concerns were not addressed.Possible causes of staff shortages in facilities included problems with hiring and assigning health workers to facilities where they were needed; lack of funding; poor management and bureaucratic systems; and low salaries. Skilled birth attendants and their managers suggested factors that could help recruit, keep, and motivate

Skill improvement among coalition members in the California Healthy Cities and Communities Program.

Science.gov (United States)

Kegler, Michelle C; Norton, Barbara L; Aronson, Robert

2007-06-01

Community-driven, collaborative approaches to health promotion have the potential to enhance skills among community members and, in turn, increase community capacity. This study uses data from an evaluation of the California Healthy Cities and Communities (CHCC) Program to examine whether, and how, community problem-solving and collaboration skills are improved among coalition members and local coordinators in 20 participating communities. Methods include semi-structured interviews with coordinators and mailed surveys with coalition members (n=330 in planning phase and n=243 in implementation phase). The largest number of coordinators reported skill improvement in defining health broadly and assessing needs and assets. Similarly, coalition members reported greatest skill improvement for defining health broadly, assessing needs and assets and setting priorities and developing action plans. Modest correlations were observed between number of roles played in the local healthy cities and communities project and each skill area assessed. Time committed to the local CHCC coalition and its activities was not meaningfully correlated with any of the skills. Types of skill-building opportunities may be more important than number of hours devoted to meetings and activities in strengthening community problem-solving and collaboration skills among coalition members.

Empowerment, intimate partner violence and skilled birth attendance among women in rural Uganda.

Science.gov (United States)

Kwagala, Betty; Nankinga, Olivia; Wandera, Stephen Ojiambo; Ndugga, Patricia; Kabagenyi, Allen

2016-05-04

There is limited research on how the empowerment of women and intimate partner violence (IPV) are associated with skilled birth attendance (SBA) among rural women in Uganda. Therefore, the aim of this paper was to investigate the association between women's empowerment, their experience of IPV and SBA in rural Uganda. Using data from the Uganda Demographic and Health Survey (UDHS), we selected 857 rural women who were in union, had given birth in the last 5 years preceding the survey and were selected for the domestic violence (DV) module. Frequency distributions were used to describe the background characteristics of the women and their partners. Pearson's chi-squared (χ (2)) tests were used to investigate the associations between SBA and women's empowerment; and partners' and women's socio-demographic factors including sexual violence. Multivariable logistic regression analyses were used to examine the association between SBA and explanatory variables. More than half (55 %) of the women delivered under the supervision of skilled birth attendant. Women's empowerment with respect to participation in household decision-making, property (land and house) (co)ownership, IPV, and sexual empowerment did not positively predict SBA among rural women in Uganda. Key predictors of SBA were household wealth status, partners' education, ANC attendance and parity. For enhancement of SBA in rural areas, there is a need to encourage a more comprehensive ANC attendance irrespective of number of children a woman has; and design interventions to enhance household wealth and promote men's education.

Improving coverage of postnatal care in rural Ethiopia using a community-based, collaborative quality improvement approach.

Science.gov (United States)

Tesfaye, Solomon; Barry, Danika; Gobezayehu, Abebe Gebremariam; Frew, Aynalem Hailemichael; Stover, Kim Ethier; Tessema, Hana; Alamineh, Lamesgin; Sibley, Lynn M

2014-01-01

Ethiopia has high maternal and neonatal mortality and low use of skilled maternity care. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), a 3.5-year learning project, used a community collaborative quality improvement approach to improve maternal and newborn health care during the birth-to-48-hour period. This study examines how the promotion of community maternal and newborn health (CMNH) family meetings and labor and birth notification contributed to increased postnatal care within 48 hours by skilled providers or health extension workers. Baseline and endline surveys, monthly quality improvement data, and MaNHEP's CMNH change package, a compendium of the most effective changes developed and tested by communities, were reviewed. Logistic regression assessed factors associated with postnatal care receipt. Monthly postnatal care receipt was plotted with control charts. The baseline (n = 1027) and endline (n = 1019) surveys showed significant increases in postnatal care, from 5% to 51% and from 15% to 47% in the Amhara and Oromiya regions, respectively (both P care. Women with any antenatal care were 1.7 times more likely to have had a postnatal care visit (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.10-2.54; P care (OR, 4.86; 95% CI, 2.67-8.86; P care far exceeds the 7% postnatal care coverage rate reported in the 2011 Ethiopian Demographic and Health Survey (EDHS). This result was linked to ideas generated by community quality improvement teams for labor and birth notification and cooperation with community-level health workers to promote antenatal care and CMNH family meetings. © 2014 by the American College of Nurse-Midwives.

Factors influencing choice of skilled birth attendance at ANC: evidence from the Kenya demographic health survey.

Science.gov (United States)

Nyongesa, Caroline; Xu, Xiaoyue; Hall, John J; Macharia, William M; Yego, Faith; Hall, Brigid

2018-04-10

In Kenya, skilled attendance at delivery is well below the international target of 90% and the maternal mortality ratio is high at 362 (CI 254-471) per 100,000 live births despite various interventions. The preventative role of skilled attendance at delivery makes it a benchmark indicator for safe motherhood. Maternal health data from the Service Provision Assessment Survey, a subset of the 2010 Kenya Demographic Health Survey was analyzed. Logistic regression models were employed using likelihood ratio test to explore association between choice of skilled attendance and predictor variables. Overall, 94.8% of women are likely to seek skilled attendance at delivery. Cost, education level, number of antenatal visits and sex of provider were strongly associated with client's intention to deliver with a skilled birth attendant at delivery. Women who reported having enough money set aside for delivery were 4.34 (p < 0.002, 95% CI: 1.73; 10.87) times more likely to seek skilled attendance. Those with primary education and above were 6.6 times more likely to seek skilled attendance than those with no formal education (p < 0.001, 95% CI: 3.66; 11.95). Women with four or more antenatal visits were 5.95 (p < 0.018, 95% CI: 1.35; 26.18) times more likely to seek skilled attendance. Compared to men, female providers impacted more on the client's plan (OR = 2.02 (p < 0.014, 95% CI: 1.35; 3.53). Interventions aimed at improving skilled attendance at delivery should include promotion of formal education of women and financial preparation for delivery. Whenever circumstances permit, women should be allowed to choose gender of preferred professional attendant at delivery.

Effects of community participation on improving uptake of skilled care for maternal and newborn health: a systematic review.

Directory of Open Access Journals (Sweden)

Cicely Marston

Full Text Available Despite a broad consensus that communities should be actively involved in improving their own health, evidence for the effect of community participation on specific health outcomes is limited. We examine the effectiveness of community participation interventions in maternal and newborn health, asking: did participation improve outcomes? We also look at how the impact of community participation has been assessed, particularly through randomised controlled trials, and make recommendations for future research. We highlight the importance of qualitative investigation, suggesting key areas for qualitative data reporting alongside quantitative work.Systematic review of published and 'grey' literature from 1990. We searched 11 databases, and followed up secondary references. Main outcome measures were the use of skilled care before/during/after birth and maternal/newborn mortality/morbidity. We included qualitative and quantitative studies from any country, and used a community participation theoretical framework to analyse the data. We found 10 interventions. Community participation had largely positive impacts on maternal/newborn health as part of a package of interventions, although not necessarily on uptake of skilled care. Interventions improving mortality or use of skilled care raised awareness, encouraged dialogue and involved communities in designing solutions-but so did those showing no effect.There are few high-quality, quantitative studies. We also lack information about why participation interventions do/do not succeed - an area of obvious interest for programme designers. Qualitative investigation can help fill this information gap and should be at the heart of future quantitative research examining participation interventions - in maternal/newborn health, and more widely. This review illustrates the need for qualitative investigation alongside RCTs and other quantitative studies to understand complex interventions in context, describe

Distance from health facility and mothers' perception of quality related to skilled delivery service utilization in northern Ethiopia.

Science.gov (United States)

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-01-01

Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.

Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

Science.gov (United States)

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-01-01

Background Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. Subjects and methods A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). Results A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Conclusion Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current

Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?

Science.gov (United States)

Lee, Anne CC; Lawn, Joy E.; Cousens, Simon; Kumar, Vishwajeet; Osrin, David; Bhutta, Zulfiqar A.; Wall, Steven N.; Nandakumar, Allyala K.; Syed, Uzma; Darmstadt, Gary L.

2012-01-01

Background Delays in receiving effective care during labor and at birth may be fatal for the mother and fetus, contributing to 2 million annual intrapartum stillbirths and intrapartum-related neonatal deaths each year. Objective We present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes. Results There is moderate quality evidence that community mobilization with high levels of community engagement can increase institutional births and significantly reduce perinatal and early neonatal mortality. Meta-analysis showed a doubling of skilled birth attendance and a 35% reduction in early neonatal mortality. However, no data are available on intrapartum-specific outcomes. Evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown. Current evidence for maternity waiting homes and risk screening is low quality. Conclusions Empowering communities is an important strategy to reduce the large burden of intrapartum complications. Innovations are needed to bring the poor closer to obstetric care, such as financial incentives and cell phone technology. New questions need to be asked of “old” strategies such as risk screening and maternity waiting homes. The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation. PMID:19815201

IMPROVING THE HARD SKILLS AND SOFT SKILLS OF MADRASAH TEACHERS FOR DEALING ASEAN ECONOMIC COMMUNITY (AEC

Directory of Open Access Journals (Sweden)

Laely Mahmudah

2016-11-01

Full Text Available ASEAN Economic Community (AEC has been started rolling. Market competition, industry, and skilled workers, especially in the field of education are becoming increasingly stringent. Madrasah teachers as the front liners in the education process should improve the quality of human resources. Hard skills and soft skills of madrasah teachers must be improved to deal with the Asean Economic Community (AEC. Hard skills are academic skills that include pedagogic competence and professional competence. How to improve the hard skills is to meet the pedagogic competence (ability to manage learning students and professional competence (the ability to master the learning material is broad and deep. Soft skills is the ability to organize themselves (intrapersonal skills, such as creativity, motivation, and self-contained and the ability to interact with others (interpersonal skills, such as communication, team building and adaptation to maximize performance. Soft skills include personal competence and social competence. Madrasah teachers should be able to change the mindset of a passenger became good driver. Professional madrasah teachers are teachers who have the balanced hard skills and soft skills, which can compete healthily in AEC era.

Safe delivery care practices in western Nepal: Does women’s autonomy influence the utilization of skilled care at birth?

Science.gov (United States)

Kutty, V. Raman; Sarma, P. Sankara; Dangal, Ganesh

2017-01-01

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives—women’s autonomy—plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women’s autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women’s autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women’s education had a strong positive association (odds ratio = 24.11, CI = 9.43–61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women’s education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband’s education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women’s autonomy may be an important mediating factor in this pathway. PMID:28771579

Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans.

Science.gov (United States)

Amoah, Benjamin; Anto, Evelyn A; Osei, Prince K; Pieterson, Kojo; Crimi, Alessandro

2016-06-14

The World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. With the aim of increasing number of ANC visits, reducing home deliveries, and supplementing care given by ANC clinics, a proposed system based on low-cost mobile phones and portable ultrasound scan machines was piloted. A sample of 323 pregnant women from four rural communities in the Central Region of Ghana were followed within a 11-month project. In each community, at least one health worker was trained and equipped with a mobile phone to promote ANC and hospital deliveries in her own community. If women cannot attend ANC, technicians acquired scans by using portable ultrasound machines in her community directly and sent them almost in real time to be analyzed by a gynecologist in an urban hospital. A preliminary survey to assess ANC status preceding the pilot study was conducted. During this, one hundred women who had had pregnancies within five years prior to the study were interviewed. The preliminary survey showed that women who attended ANC were less likely to have a miscarriage and more likely to have delivery at hospital or clinic than those who did not, and women who attained at least four ANC visits were less likely to practice self-medication. Among the women involved in the project, 40 gave birth during the period of observation. The proposed prenatal care approach showed that 62.5 % of pregnant women who gave birth during the observation period included in the project (n=40) had their labor attended in clinics or hospitals as against 37.5 % among the cases reported in the pre-survey. One case of ectopic and two cases of breech pregnancies were detected during the pilot through the proposed approach, and appropriate medical interventions were sought. Our results show that the proposed

Community Living Skills Guide: Art.

Science.gov (United States)

Sobol, Sheila; Kreps, Alice Roelofs

One of twenty course guides in the Community Living Skills Guide for the College for Living series, this document provides guidelines and workbook activities for the course, Art. The series of courses for developmentally disabled adults is intended to supplement residential programs and to aid in orienting institutionalized persons to eventual…

Delaying second births among adolescent mothers: a randomized, controlled trial of a home-based mentoring program.

Science.gov (United States)

Black, Maureen M; Bentley, Margaret E; Papas, Mia A; Oberlander, Sarah; Teti, Laureen O; McNary, Scot; Le, Katherine; O'Connell, Melissa

2006-10-01

Rates of rapid second births among low-income black adolescent mothers range from 20% to 50%. Most efforts to prevent rapid second births have been unsuccessful. There were 4 objectives: (1) to examine whether a home-based mentoring intervention was effective in preventing second births within 2 years of the adolescent mother's first delivery; (2) to examine whether greater intervention participation increased the likelihood of preventing a second birth; (3) to examine whether second births were better predicted from a risk practice perspective or a family formation perspective, based on information collected at delivery; and (4) to examine how risk practices or family formation over the first 2 years of parenthood were related to a second birth. We conducted a randomized, controlled trial of a home-based intervention curriculum, based on social cognitive theory, and focused on interpersonal negotiation skills, adolescent development, and parenting. The curriculum was delivered biweekly until the infant's first birthday by college-educated, black, single mothers who served as mentors, presenting themselves as "big sisters." The control group received usual care. Follow-up evaluations were conducted in the homes 6, 13, and 24 months after recruitment. Participants were recruited from urban hospitals at delivery and were 181 first time, black adolescent mothers ( or = 2 intervention visits increased the odds of not having a second infant more than threefold. Only 1 mother who completed > or = 6 visits had a second infant. At delivery of their first infant, mothers who had a second infant were slightly older (16.7 vs 16.2 years) and were more likely to have been arrested (30% vs 14%). There were no differences in baseline contraceptive use or other measures of risk or family formation. At 24 months, mothers who had a second infant reported high self-esteem, positive life events, and romantic involvement and residence with the first infant's father. At 24 months, there

Construction of HMI Network System for Individualized Maternity Intervention Service against Birth Defects in Community

Institute of Scientific and Technical Information of China (English)

Xu-huai HU

2007-01-01

The paper expounds the community maternity service system against birth defects,from the viewpoint of individualized service in family planning. We have utilized modern information technology to develop health management information (HMI) network with individualized maternity, and to establish the community service system for intervention of birth defects. The service system applied the concept of modern health management information to implementing informational management for screening,treatment, following up, outcome monitoring, so as to provide a base for promotion of health, diagnosis, treatment as well as scientific research, with the prenatal screening of Down's syndrome as a model. The introduction to informational network during the processes of service has been carried out with regards to its composition, function and application, while introducing the effects of computerized case record individualized in prevention, management and research of Down's syndrome.

Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study

Directory of Open Access Journals (Sweden)

Miteku Andualem Limenih

2016-01-01

Full Text Available Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34, place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79, outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19, delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54, and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28 were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study.

Science.gov (United States)

Limenih, Miteku Andualem; Endale, Zerfu Mulaw; Dachew, Berihun Assefa

2016-01-01

Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

Birth preparedness, complication readiness and fathers' participation in maternity care in a northern Nigerian community.

Science.gov (United States)

Iliyasu, Zubairu; Abubakar, Isa S; Galadanci, Hadiza S; Aliyu, Muktar H

2010-03-01

The role of men in maternity care in Africa is understudied, despite their economic dominance and decision making power. In a patriarchal society like northern Nigeria, pregnancy and childbirth are often regarded as exclusively women's affairs. Using data from interviewer administered questionnaires and in-depth interviews; we assessed birth preparedness, complication readiness and male participation in maternity care in Ungogo, a northern Nigerian community. Majority of pregnancies were unplanned (96%). Only 32.1% of men ever accompanied their spouses for maternity care. There was very little preparation for skilled assistance during delivery (6.2%), savings for emergencies (19.5%) or transportation during labour (24.2%). Young paternal age (adjusted odds ratio [AOR] = 1.5, 95% confidence interval [CI] = 1.2-2.6), formal education (AOR = 1.9, 95% CI=1.1-3.4) and non-Hausa Fulani ethnicity (AOR=2.3, 95% CI = 1.4-3.3) were independent predictors of male participation in maternity care. There is a need to increase involvement of men in their partner's maternity care through peer-led, culturally-sensitive community education and appropriate health system reforms.

Teaching Young Adults with Intellectual and Developmental Disabilities Community-Based Navigation Skills to Take Public Transportation.

Science.gov (United States)

Price, Richard; Marsh, Abbie J; Fisher, Marisa H

2018-03-01

Facilitating the use of public transportation enhances opportunities for independent living and competitive, community-based employment for individuals with intellectual and developmental disabilities (IDD). Four young adults with IDD were taught through total-task chaining to use the Google Maps application, a self-prompting, visual navigation system, to take the bus to locations around a college campus and the community. Three of four participants learned to use Google Maps to independently navigate public transportation. Google Maps may be helpful in supporting independent travel, highlighting the importance of future research in teaching navigation skills. Learning to independently use public transportation increases access to autonomous activities, such as opportunities to work and to attend postsecondary education programs on large college campuses.Individuals with IDD can be taught through chaining procedures to use the Google Maps application to navigate public transportation.Mobile map applications are an effective and functional modern tool that can be used to teach community navigation.

Community-level Distribution of Misoprostol to Prevent Postpartum ...

African Journals Online (AJOL)

In Nigeria, most deaths due to postpartum hemorrhage (PPH) occur in the absence of skilled birth attendants. A study using community mobilization and the training of community drug keepers to increase access to misoprostol for PPH prevention was conducted in five communities around Zaria in Kaduna State, Nigeria.

Determination of sex-ratio by birth order in an urban community in Manipur.

Science.gov (United States)

Brogen, Akoijam S; Shantibala, K; Rajkumari, Bishwalata; Laishram, Jalina

2009-01-01

To determine the sex ratio by birth order and to assess the sex preference of the couples in an urban community. A cross sectional study, in an urban community in Manipur, was conducted among the currently married couples. Data on background characteristics of the couple, family pedigree chart (of the offspring) including history of abortion, stillbirth, death of child of the couple, sex preference and Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act [PNDT Act] were collected through a structured interview. Data were analyzed using descriptive and chi-square statistics. There were a total of 1777 births to the 855 couples interviewed. There were 900 females per 1000 males for the 1st birth order but the sex ratio was favorable towards females in the 2nd, 3rd and 4th birth orders. Among both the husbands and wives, being more educated was significantly associated (p<0.05) with preferring lesser number of children, using new technology for sex selection and having heard of the PNDT Act. Majority of those who wanted to use new technology for sex selection (128, 56.6%) preferred to have male child. Sex ratio in this community was favorable towards females, though it was less among the first born babies.

Towards universal access to skilled birth attendance: the process of transforming the role of traditional birth attendants in Rural China.

Science.gov (United States)

Jiang, Hong; Qian, Xu; Chen, Lili; Li, Jian; Escobar, Erin; Story, Mary; Tang, Shenglan

2016-03-21

Institution-based childbirth, with the ultimate goal of universal access to skilled birth attendance (SBA), has been selected as a key strategy to reduce the maternal mortality rate in many developing countries. However, the question of how to engage traditional birth attendants (TBAs) in the advocacy campaign for SBA poses a number of challenges. This paper aims to demonstrate how TBAs in rural regions of China have been integrated into the health system under a policy of institutional delivery. Research was conducted through literature and document reviews and individual in-depth interviews with stakeholders of the safe motherhood program in rural Guangxi Zhuang Autonomous Region, China. A total of 33 individual interviews were conducted with regional and local politicians, policy makers, health managers, health providers, civil society members, village cadres for women affairs, former TBAs, village maternal health workers, mothers and their mother-in-laws. Since 1998, TBA's traditional role of providing in-home care during childbirth has been restructured and their social role has been strengthened in rural Guangxi. TBAs were redesigned to function as the linkage between women and the health system. A new policy in 1999 shifted the role of TBAs to village maternal health workers whose responsibilities were mainly to promote perinatal care and institution-based delivery of pregnant women. This successful transformation involved engaging with government and other actors, training TBAs for their new role, and providing incentives and sanctions for human resources management. The China experience of transforming the role of TBAs in Guangxi rural area is an example of successfully engaging TBAs in promoting institution-based childbirth.

Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 - 2008.

Science.gov (United States)

Asamoah, Benedict O; Agardh, Anette; Pettersson, Karen Odberg; Östergren, Per-Olof

2014-08-29

Improving maternal and reproductive health still remains a major challenge in most low-income countries especially in sub-Saharan Africa. The growing inequality in access to maternal health interventions is an issue of great concern. In Ghana, inadequate attention has been given to the inequality gap that exists amongst women when accessing antenatal care during pregnancy and skilled attendance at birth. This study therefore aimed at investigating the magnitude and trends in income-, education-, residence-, and parity-related inequalities in access to antenatal care and skilled attendance at birth. A database was constructed using data from the Ghana Demographic and Health Surveys (DHS) 1988, 1993, 1998, 2003, and 2008. The surveys employed standard DHS questionnaires and techniques for data collection. We applied regression-based Total Attributable Fraction (TAF) as an index for measuring socioeconomic inequalities in antenatal care and skilled birth attendance utilization. The rural-urban gap and education-related inequalities in the utilization of antenatal care and skilled birth attendants seem to be closing over time, while income- and parity-related inequalities in the use of antenatal care are on a sharp rise. Income inequality regarding the utilization of skilled birth attendance was rather low and stable from 1988 to 1998, increased sharply to a peak between 1998 and 2003, and then leveled-off after 2003. The increased income-related inequalities seen in the use of antenatal care and skilled birth attendance should be addressed through appropriate strategies. Intensifying community-based health education through media and door-to-door campaigns could further reduce the mentioned education- and parity-related inequalities. Women should be highly motivated and incentivized to attend school up to secondary level or higher. Education on the use of maternal health services should be integrated into basic schools so that women at the lowest level would be

Assessing Community Based Improved Maternal Neonatal Child Survival (IMNCS Program in Rural Bangladesh.

Directory of Open Access Journals (Sweden)

Mahfuzar Rahman

Full Text Available A community based approach before, during and after child birth has been proven effective address the burden of maternal, neonatal and child morbidity and mortality in the low and middle income countries. We aimed to examine the overall change in maternal and newborn health outcomes due the "Improved Maternal Newborn and Child Survival" (IMNCS project, which was implemented by BRAC in rural communities of Bangladesh.The intervention was implemented in four districts for duration of 5-years, while two districts served as comparison areas. The intervention was delivered by community health workers who were trained on essential maternal, neonatal and child health care services. A baseline survey was conducted in 2008 among 7, 200 women with pregnancy outcome in last year or having a currently alive child of 12-59 months. A follow-up survey was administered in 2012-13 among 4, 800 women of similar characteristics in the same villages.We observed significant improvements in maternal and essential newborn care in intervention areas over time, especially in health care seeking behaviors. The proportion of births taking place at home declined in the intervention districts from 84.3% at baseline to 71.2% at end line (P<0.001. Proportion of deliveries with skilled attendant was higher in intervention districts (28% compared to comparison districts (27.4%. The number of deliveries was almost doubled at public sector facility comparing with baseline (P<0.001. Significant improvement was also observed in healthy cord care practice, delayed bathing of the new-born and reduction of infant mortality in intervention districts compared to that of comparison districts.This study demonstrates that community-based efforts offer encouraging evidence and value for combining maternal, neonatal and child health care package. This approach might be considered at larger scale in similar settings with limited resources.

Identifying and Assessing Community-Based Social Behavior of Adolescents and Young Adults with EBD.

Science.gov (United States)

Bullis, Michael; And Others

1994-01-01

A battery of three measures for assessing the community-based social behavior of adolescents and young adults with emotional and behavioral disorders is described. The measures, in male and female forms, are "Test of Community-Based Social Skill Knowledge,""Scale of Community-Based Social Skill Performance," and "Behaviors That Are Undesirable for…

Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study.

Science.gov (United States)

Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H; Ruiter, Robert A C

2015-09-11

Despite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women's preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia. We conducted ten focus group discussions (n = 100) with women of reproductive age (15-45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored. Our findings show that women's lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them. Our findings suggest a need to empower women with decision-making skills

Collection, use, and protection of population-based birth defects surveillance data in the united states.

Science.gov (United States)

Mai, Cara T; Law, David J; Mason, Craig A; McDowell, Bradley D; Meyer, Robert E; Musa, Debra

2007-12-01

Birth defects surveillance systems collect population-based birth defects data from multiple sources to track trends in prevalence, identify risk factors, refer affected families to services, and evaluate prevention efforts. Strong state and federal public health and legal mandates are in place to govern the collection and use of these data. Despite the prima facie appeal of "opt-in" and similar strategies to those who view data collection as a threat to privacy, the use of these strategies in lieu of population-based surveillance can severely limit the ability of public health agencies to accurately access the health status of a group within a defined geographical area. With the need for population-based data central to their mission, birth defects programs around the country take their data stewardship role seriously, recognizing both moral and legal obligations to protect the data by employing numerous safeguards. Birth defects surveillance systems are shaped by the needs of the community they are designed to serve, with the goal of preventing birth defects or alleviating the burdens associated with them. (c) 2007 Wiley-Liss, Inc.

Community-based evaluation of PMTCT uptake in Nyanza Province, Kenya.

Directory of Open Access Journals (Sweden)

Pamela K Kohler

Full Text Available Facility-based assessments of prevention of mother-to-child HIV transmission (PMTCT programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake.During 2011, a cross-sectional community survey among women who gave birth in the prior year was performed using the KEMRI-CDC Health and Demographic Surveillance System in Western Kenya. A random sample (n = 405 and a sample of women known to be HIV-positive through previous home-based testing (n = 247 were enrolled. Rates and correlates of uptake of antenatal care (ANC, HIV-testing, and antiretrovirals (ARVs were determined.Among 405 women in the random sample, 379 (94% reported accessing ANC, most of whom (87% were HIV tested. Uptake of HIV testing was associated with employment, higher socioeconomic status, and partner HIV testing. Among 247 known HIV-positive women, 173 (70% self-disclosed their HIV status. Among 216 self-reported HIV-positive women (including 43 from the random sample, 82% took PMTCT ARVs, with 54% completing the full antenatal, peripartum, and postpartum course. Maternal ARV use was associated with more ANC visits and having an HIV tested partner. ARV use during delivery was lowest (62% and associated with facility delivery. Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment.Community-based assessments provide data that complements clinic-based PMTCT evaluations. In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team. Community-driven strategies that encourage early ANC, partner involvement, and skilled delivery, and provide PMTCT education, may facilitate further reductions in vertical transmission.

Reflections on the Unintended Consequences of the Promotion of Institutional Pregnancy and Birth Care in Burkina Faso.

Directory of Open Access Journals (Sweden)

Andrea Melberg

Full Text Available The policy of institutional delivery has been the cornerstone of actions aimed at monitoring and achieving MDG 5. Efforts to increase institutional births have been implemented worldwide within different cultural and health systems settings. This paper explores how communities in rural Burkina Faso perceive the promotion and delivery of facility pregnancy and birth care, and how this promotion influences health-seeking behaviour. A qualitative study was conducted in South-Western Burkina Faso between September 2011 and January 2012. A total of 21 in-depth interviews and 8 focus group discussions with women who had given birth recently and community members were conducted. The data were analyzed using qualitative content analysis and interpreted through Merton's concept of unintended consequences of purposive social action. The study found that community members experienced a strong pressure to give birth in a health facility and perceived health workers to define institutional birth as the only acceptable option. Women and their families experienced verbal, economic and administrative sanctions if they did not attend services and adhered to health worker recommendations, and reported that they felt incapable of questioning health workers' knowledge and practices. Women who for social and economic reasons had limited access to health facilities found that the sanctions came with increased cost for health services, led to social stigma and acted as additional barriers to seek skilled care at birth. The study demonstrates how the global and national policy of skilled pregnancy and birth care can occur in unintentional ways in local settings. The promotion of institutional care during pregnancy and at birth in the study area compromised health system trust and equal access to care. The pressure to use facility care and the sanctions experienced by women not complying may further marginalize women with poor access to facility care and contribute to

Reflective learning in community-based dental education.

Science.gov (United States)

Deogade, Suryakant C; Naitam, Dinesh

2016-01-01

Community-based dental education (CBDE) is the implementation of dental education in a specific social context, which shifts a substantial part of dental clinical education from dental teaching institutional clinics to mainly public health settings. Dental students gain additional value from CBDE when they are guided through a reflective process of learning. We propose some key elements to the existing CBDE program that support meaningful personal learning experiences. Dental rotations of 'externships' in community-based clinical settings (CBCS) are year-long community-based placements and have proven to be strong learning environments where students develop good communication skills and better clinical reasoning and management skills. We look at the characteristics of CBDE and how the social and personal context provided in communities enhances dental education. Meaningfulness is created by the authentic context, which develops over a period of time. Structured reflection assignments and methods are suggested as key elements in the existing CBDE program. Strategies to enrich community-based learning experiences for dental students include: Photographic documentation; written narratives; critical incident reports; and mentored post-experiential small group discussions. A directed process of reflection is suggested as a way to increase the impact of the community learning experiences. We suggest key elements to the existing CBDE module so that the context-rich environment of CBDE allows for meaningful relations and experiences for dental students and enhanced learning.

Effect of Community-Based Social Skills Training and Tai-Chi Exercise on Outcomes in Patients with Chronic Schizophrenia: A Randomized, One-Year Study.

Science.gov (United States)

Kang, Ruiying; Wu, Yeqing; Li, Zhiwu; Jiang, Jun; Gao, Qi; Yu, Yuncui; Gao, Keming; Yan, Yuxiang; He, Yan

Antipsychotic drugs are limited in their ability to improve negative symptoms, quality of life, and medication adherence in patients with schizophrenia. The addition of nonpharmacological interventions like social skills training has a positive effect on medication adherence and decreases rehospitalization rates but is limited in improving patients' symptoms, aggressive behaviors, and quality of life. Aerobic exercise, especially Tai-chi, can potentially reduce psychopathological and negative symptoms, decrease aggressive behaviors, and improve quality of life. It is an ideal rehabilitation intervention for patients with schizophrenia. However, no study has investigated the effects of social skills training plus Tai-chi on outcomes among outpatients with schizophrenia. This study analyzes the effect of antipsychotics combined with community-based integrated interventions on outcomes of schizophrenia. In this study, a 24-session social skills training plus Tai-chi was used in community settings among patients with schizophrenia. A total of 244 patients were randomly assigned to medication treatment alone (MTA group) or community-based integrated intervention (CBII group), which accepted social skills training plus Tai-chi in addition to medication treatment. Generalized linear mixed models were used to evaluate the intervention effect (group effect), intervention effect over time (time effect), and interaction effect (group × time effect). t tests were used to evaluate between-group differences on clinical variables. Multiple linear regression analysis was used to analyze the differences between the intervention at 12 months and baseline for the Positive and Negative Syndrome Scale (PANSS) negative symptoms and quality of life-social domain. Compared with the MTA group, the CBII group had lower scores on PANSS (F = 17.312, p social domain of the World Health Organization Quality of Life Scale-Brief version (WHOQOL-BREF) from baseline to 12 months were significant

Peer-driven quality improvement among health workers and traditional birth attendants in Sierra Leone: linkages between providers' organizational skills and relationships.

Science.gov (United States)

Higgins-Steele, Ariel; Waller, Kathryn; Fotso, Jean Christophe; Vesel, Linda

2015-01-01

Sierra Leone has among the poorest maternal and child health indicators in the world and investments in public health have been predominately to increase demand for services, with fewer initiatives targeting supply side factors that influence health workers' work environment. This paper uses data from the Quality Circles project in a rural district of Sierra Leone to achieve three objectives. First, we examine the effect of the intervention on organizational skills and relationships among coworkers as well as between health workers and traditional birth attendants. Second, we examine whether changes in organizational skills are associated with changes in relationships among and between formal and informal health providers and between health providers and clients. Third, we aim to further understand these changes through the perspectives of health workers and traditional birth attendants. The Quality Circles project was implemented in Kailahun District in the Eastern province of Sierra Leone from August 2011 to June 2013, with adjacent Tonkolili District serving as the control site. Using a mixed-methods approach, the evaluation included a quantitative survey, in-depth interviews and focus group discussions with health workers and traditional birth attendants. Mean values of the variables of interest were compared across sub-populations, and correlation analyses were performed between changes in organizational skills and changes in relationships. The results demonstrate that the Quality Circles intervention had positive effects on organizational skills and relationships. Furthermore, improvements in all organizational skill variables - problem-solving, strategizing and negotiation skills - were strongly associated with a change in the overall relationship variable. The Quality Circles approach has the potential to support health workers to improve their organizational skills and relationships, which in turn can contribute to improving the interpersonal dimensions of

Peer-driven quality improvement among health workers and traditional birth attendants in Sierra Leone: linkages between providers’ organizational skills and relationships

Science.gov (United States)

2015-01-01

Background Sierra Leone has among the poorest maternal and child health indicators in the world and investments in public health have been predominately to increase demand for services, with fewer initiatives targeting supply side factors that influence health workers’ work environment. This paper uses data from the Quality Circles project in a rural district of Sierra Leone to achieve three objectives. First, we examine the effect of the intervention on organizational skills and relationships among coworkers as well as between health workers and traditional birth attendants. Second, we examine whether changes in organizational skills are associated with changes in relationships among and between formal and informal health providers and between health providers and clients. Third, we aim to further understand these changes through the perspectives of health workers and traditional birth attendants. Methods The Quality Circles project was implemented in Kailahun District in the Eastern province of Sierra Leone from August 2011 to June 2013, with adjacent Tonkolili District serving as the control site. Using a mixed-methods approach, the evaluation included a quantitative survey, in-depth interviews and focus group discussions with health workers and traditional birth attendants. Mean values of the variables of interest were compared across sub-populations, and correlation analyses were performed between changes in organizational skills and changes in relationships. Results The results demonstrate that the Quality Circles intervention had positive effects on organizational skills and relationships. Furthermore, improvements in all organizational skill variables – problem-solving, strategizing and negotiation skills – were strongly associated with a change in the overall relationship variable. Conclusions The Quality Circles approach has the potential to support health workers to improve their organizational skills and relationships, which in turn can contribute

Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh

Directory of Open Access Journals (Sweden)

Sarika Chaturvedi

2015-07-01

Full Text Available Background: Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. Design: 1 Non-participant observations (n=18 of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2 Interviews (n=10 with providers to explore reasons for this care. Thematic framework analysis was used. Results: Three themes emerged from the data: 1 delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2 Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3 Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as ‘go-betweens’ patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Conclusions: Our observational study did not suggest an adequate level of skilled birth attendance (SBA. The findings reveal insufficiencies in the health system and organisational structures to provide an �

Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh.

Science.gov (United States)

Chaturvedi, Sarika; De Costa, Ayesha; Raven, Joanna

2015-01-01

Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as 'go-betweens' patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an 'enabling environment' for SBA. We highlight the need to ensure

Evaluating community-based public health leadership training.

Science.gov (United States)

Ceraso, Marion; Gruebling, Kirsten; Layde, Peter; Remington, Patrick; Hill, Barbara; Morzinski, Jeffrey; Ore, Peggy

2011-01-01

Addressing the nation's increasingly complex public health challenges will require more effective multisector collaboration and stronger public health leadership. In 2005, the Healthy Wisconsin Leadership Institute launched an annual, year-long intensive "community teams" program. The goal of this program is to develop collaborative leadership and public health skills among Wisconsin-based multisectoral teams mobilizing their communities to improve public health. To measure the scope of participation and program impacts on individual learning and practice, including application of new knowledge and collective achievements of teams on coalition and short-term community outcomes. End-of-year participant program evaluations and follow-up telephone interviews with participants 20 months after program completion. Community-based public health leadership training program. Sixty-eight participants in the Community Teams Program during the years 2006 to 2007 and 2007 to 2008. Professional diversity of program participants; individual learning and practice, including application of new knowledge; and collective achievements of teams, including coalition and short-term community outcomes. Participants in the Community Teams Program represent a diversity of sectors, including nonprofit, governmental, academic, business, and local public health. Participation increased knowledge across all public health and leadership competency areas covered in the program. Participating teams reported outcomes, including increased engagement of community leadership, expansion of preventive services, increased media coverage, strengthened community coalitions, and increased grant funding. Evaluation of this community-based approach to public health leadership training has shown it to be a promising model for building collaborative and public health leadership skills and initiating sustained community change for health improvement.

An iPad™-based picture and video activity schedule increases community shopping skills of a young adult with autism spectrum disorder and intellectual disability.

Science.gov (United States)

Burckley, Elizabeth; Tincani, Matt; Guld Fisher, Amanda

2015-04-01

To evaluate the iPad 2™ with Book Creator™ software to provide visual cues and video prompting to teach shopping skills in the community to a young adult with an autism spectrum disorder and intellectual disability. A multiple probe across settings design was used to assess effects of the intervention on the participant's independence with following a shopping list in a grocery store across three community locations. Visual cues and video prompting substantially increased the participant's shopping skills within two of the three community locations, skill increases maintained after the intervention was withdrawn, and shopping skills generalized to two untaught shopping items. Social validity surveys suggested that the participant's parent and staff favorably viewed the goals, procedures, and outcomes of intervention. The iPad 2™ with Book Creator™ software may be an effective way to teach independent shopping skills in the community; additional replications are needed.

Prospective study of determinants and costs of home births in Mumbai slums.

Science.gov (United States)

Das, Sushmita; Bapat, Ujwala; More, Neena Shah; Chordhekar, Latika; Joshi, Wasundhara; Osrin, David

2010-07-30

Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth. As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280,000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models. We described 1708 (16%) home deliveries among 10,754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai), and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location. We estimate 32,000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be productive to concentrate on intensive outreach in vulnerable areas by

Teaching Community Survival Skills to Mentally Retarded Adults: A Review and Analysis.

Science.gov (United States)

Martin, James E.; And Others

1982-01-01

The article reviews research on training mentally retarded adults in the following community survival skills: travel training, money management, meal preparation, clothing and personal care, telephone skill, housekeeping, self-medication, leisure skills, social skills, and conversation. Results are said to indicate the value of behavioral…

Using community-based participatory research and organizational diagnosis to characterize relationships between community leaders and academic researchers.

Science.gov (United States)

Wang, Karen H; Ray, Natasha J; Berg, David N; Greene, Ann T; Lucas, Georgina; Harris, Kenn; Carroll-Scott, Amy; Tinney, Barbara; Rosenthal, Marjorie S

2017-09-01

Sustaining collaborations between community-based organization leaders and academic researchers in community-engaged research (CEnR) in the service of decreasing health inequities necessitates understanding the collaborations from an inter-organizational perspective. We assessed the perspectives of community leaders and university-based researchers conducting community-engaged research in a medium-sized city with a history of community-university tension. Our research team, included experts in CEnR and organizational theory, used qualitative methods and purposeful, snowball sampling to recruit local participants and performed key informant interviews from July 2011-May 2012. A community-based researcher interviewed 11 community leaders, a university-based researcher interviewed 12 university-based researchers. We interviewed participants until we reached thematic saturation and performed analyses using the constant comparative method. Unifying themes characterizing community leaders and university-based researchers' relationships on the inter-organizational level include: 1) Both groups described that community-engaged university-based researchers are exceptions to typical university culture; 2) Both groups described that the interpersonal skills university-based researchers need for CEnR require a change in organizational culture and training; 3) Both groups described skepticism about the sustainability of a meaningful institutional commitment to community-engaged research 4) Both groups described the historical impact on research relationships of race, power, and privilege, but only community leaders described its persistent role and relevance in research relationships. Challenges to community-academic research partnerships include researcher interpersonal skills and different perceptions of the importance of organizational history. Solutions to improve research partnerships may include transforming university culture and community-university discussions on race

Facilitators' perceptions of problem-based learning and community-based education

Directory of Open Access Journals (Sweden)

Annali E Fichardt

2000-10-01

Full Text Available In 1997 the School for Nursing, University of the Orange Free State, changed from the traditional lecture method of teaching to problem-based learning and from a curative to a community-based approach. Lecturers from a traditional environment became facilitators and new skills such as listening, dialogue, negotiation, counselling and problemsolving were expected from them. Besides the role change, the environment changed from a structural classroom to an unstructured community. The aim of this research was to determine the perceptions and experiences of facilitators in problem-based learning and community-base education. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Factors And Challenges Influencing Mothers Choice Of Birth Attendance In Bunyala Sub-County Kenya

Directory of Open Access Journals (Sweden)

June Victoria Omollo

2015-08-01

Full Text Available Despite investments made in maternal health in the developing world and a free maternal health programme being launched in Kenya maternal and neo- natal deaths in Bunyala Sub county remain high. This paper is based on a study which sought to determine the factors Influencing Mothers Choice of Birth attendance in Bunyala Sub-County Kenya. This included an examination of the challenges they face in trying to access facility-based maternity services. A sample of 385 mothers living in different locations of the sub county were surveyed using a structured questionnaire. Health personnel in the main health facility in each location were also interviewed and focus group discussions held with Community Health Workers and Traditional Birth Attendants separately. Data revealed that the mothers of Bunyala sub county generally prefer the government facilities over the TBAs primarily due to availability of skilled staff medicines and equipment. However some mothers prefer the TBAs because of flexibility of payments payments in kind accessibility at odd hours because of good relations for cultural reasonsto refrain from having male birth attendants and for fear of the mandatory HIV testing done under the PMTCT program. The challenges faced were mainly the distance to the health facility the in affordability of travel the cost of medical drugs and supplies poor roads unavailability of night time ferry services verbal abuse and negative attitudes from some skilled attendants and long waiting hours.

Traditional Birth Attendants in Rural Northern Uganda: Policy, Practice, and Ethics.

Science.gov (United States)

Rudrum, Sarah

2016-01-01

The current emphasis on skilled attendants as a means to reduce maternal mortality contributes to a discouraging policy environment for traditional birth attendants (TBAs). They continue to attend a significant number of births, however, such that their role and the policies and practices affecting their work remain important to understanding maternity health care and maternal health in the global South. In this article, I examine the policies and practices governing community elders practicing as TBAs in rural northern Uganda. This discussion is relevant to health workers in developing countries and to scholars in fields such as women's studies, sociology, and public health.

The Social and Academic Consequences of Birth Order: Real, Artifactual, or Both?

Science.gov (United States)

Steelman, Lala Carr; Powell, Brian

1985-01-01

Examined impact of birth order on social skills and academic performance of children and adolescents (N=3,568). Results revealed no significant relationship between birth order and academic performance but did reveal a significant positive relationship between birth order and social skills. Leadership skills were related to birth order for males.…

The impact of a community-based food skills intervention on cooking confidence, food preparation methods and dietary choices - an exploratory trial.

Science.gov (United States)

Wrieden, Wendy L; Anderson, Annie S; Longbottom, Pat J; Valentine, Karen; Stead, Martine; Caraher, Martin; Lang, Tim; Gray, Bill; Dowler, Elizabeth

2007-02-01

To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aimed at altering cooking confidence, food preparation methods and dietary choices. A standardised skills programme was implemented in community-based settings. Pre- (T1) and post-intervention (T2) and 6-month follow-up (T3) measures (7-day diaries and self-administered questionnaires) were undertaken in intervention and comparison groups. Eight urban communities in Scotland. One hundred and thirteen adults living in areas of social deprivation. It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic. Sixty-three subjects completed the final (T3) assessments. The response to each component varied due to inability to attend sessions, illness, study requirements, employment, moving out of the area, change in circumstances, loss of interest and loss of postal questionnaires. At baseline, reported consumption of fruit and vegetables was low (mean frequency 8.1 +/- 4.78 times per week). Fruit intake increased significantly (P food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation. A full-scale randomised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention, and presents challenges for trial design.

Starting the conversation: community perspectives on preterm birth and kangaroo mother care in southern Malawi.

Science.gov (United States)

Lydon, Megan; Longwe, Monica; Likomwa, Dyson; Lwesha, Victoria; Chimtembo, Lydia; Donohue, Pamela; Guenther, Tanya; Valsangar, Bina

2018-06-01

Despite introduction of Kangaroo Mother Care (KMC) in Malawi over a decade ago, preterm birth remains the leading cause of neonatal mortality. Although KMC is initiated in the health care facility, robust community follow-up is critical for survival and optimal development of preterm and low birth weight infants post-discharge. The objective of this qualitative study was to gain insight into community and health worker understanding, attitudes, beliefs and practices around preterm and low birth weight babies and KMC in Malawi. A total of 152 participants were interviewed in two districts in southern Malawi, Machinga and Thyolo, in April 2015. Focus group discussions (groups = 11, n = 132) were conducted with pregnant women, community members and women who have practiced KMC. In-depth interviews (n = 20) were conducted with fathers who have practiced KMC, community and religious leaders, and health workers. Purposive and snowball sampling were employed to identify participants. Thematic content analysis was conducted. KMC mothers and fathers only learned about KMC and care for preterm newborns after delivery of a child in need of this care. Men typically were not included in KMC counseling due to societal gender roles. Health facilities were the main source of information on KMC, however informal networks among women provided some degree of knowledge exchange. Community leaders were regarded as major facilitators of health information, conveners, key influencers, and policy-makers. Religious leaders were regarded as advocates and emotional support for families with preterm infants. Finally, while many participants initially had negative feelings towards preterm births and KMC, the large majority saw a shift in their perceptions through health counseling, peer modeling, and personal success with KMC. The findings offer several opportunities to improve KMC implementation including 1) earlier introduction of KMC to pregnant women and their families that are

A Community-Based Intervention to Prevent Obesity Beginning at Birth among American Indian Children: Study Design and Rationale for the PTOTS study

Science.gov (United States)

Karanja, Njeri; Aickin, Mikel; Lutz, Tam; Mist, Scott; Jobe, Jared B.; Maupomé, Gerardo; Ritenbaugh, Cheryl

2012-01-01

Eating and physical activity behaviors associated with adult obesity have early antecedents, yet few studies have focused on obesity prevention interventions targeting very young children. Efforts to prevent obesity beginning at birth seem particularly important in populations at risk for early-onset obesity. National estimates indicate that American Indian (AI) children have higher rates of overweight and obesity than children of other races/ethnicities. The Prevention of Toddler Obesity and Teeth Health Study (PTOTS) is a community-partnered randomized controlled trial designed to prevent obesity beginning at birth in AI children. PTOTS was developed to test the effectiveness of a multi-component intervention designed to: promote breastfeeding, reduce sugar-sweetened beverage consumption, appropriately time the introduction of healthy solid foods, and counsel parents to reduce sedentary lifestyles in their children. A birth cohort of 577 children from five AI tribes is randomized by tribe to either the intervention (three tribes) or the comparison condition (two tribes). The strengths and weaknesses of PTOTS include a focus on a critical growth phase, placement in the community, and intervention at many levels, using a variety of approaches. PMID:23001689

Post-neonatal mortality, morbidity, and developmental outcome after ultrasound-dated preterm birth in rural Malawi: a community-based cohort study.

Science.gov (United States)

Gladstone, Melissa; White, Sarah; Kafulafula, George; Neilson, James P; van den Broek, Nynke

2011-11-01

Preterm birth is considered to be associated with an estimated 27% of neonatal deaths, the majority in resource-poor countries where rates of prematurity are high. There is no information on medium term outcomes after accurately determined preterm birth in such settings. This community-based stratified cohort study conducted between May-December 2006 in Southern Malawi followed up 840 post-neonatal infants born to mothers who had received antenatal antibiotic prophylaxis/placebo in an attempt to reduce rates of preterm birth (APPLe trial ISRCTN84023116). Gestational age at delivery was based on ultrasound measurement of fetal bi-parietal diameter in early-mid pregnancy. 247 infants born before 37 wk gestation and 593 term infants were assessed at 12, 18, or 24 months. We assessed survival (death), morbidity (reported by carer, admissions, out-patient attendance), growth (weight and height), and development (Ten Question Questionnaire [TQQ] and Malawi Developmental Assessment Tool [MDAT]). Preterm infants were at significantly greater risk of death (hazard ratio 1.79, 95% CI 1.09-2.95). Surviving preterm infants were more likely to be underweight (weight-for-age z score; prates of developmental delay on the MDAT at 18 months (p = 0.009), with gestational age at delivery (p = 0.01) increasing this likelihood. Morbidity-visits to a health centre (93%) and admissions to hospital (22%)-was similar for both groups. During the first 2 years of life, infants who are born preterm in resource poor countries, continue to be at a disadvantage in terms of mortality, growth, and development. In addition to interventions in the immediate neonatal period, a refocus on early childhood is needed to improve outcomes for infants born preterm in low-income settings.

Comparing Effectiveness of New Training Program of Local Trainers of Community-Based Rehabilitation Program with the Current Program: A Knowledge, Attitude and Skills Study

Directory of Open Access Journals (Sweden)

Mohsen Iravani

2011-10-01

Full Text Available Objective: This research aimed at comparison effects of a new and current "training program for community rehabilitation workers of Community Based Rehabilitation", in enhancing their knowledge, attitude and skills. Materials & Methods: In this experimental field trial, a total number of 34 newly engaged local trainers in Lorestan province were divided randomly in two (16 and 18 peoplesinterventional groups based on geographical location of their work places Teaching methods were roll playing, problem solving, and learning by doing in new program and the booklets were revised in terms of fluency and a guideline booklet for trainers were added in this program but the teaching method was reading booklets and demonstration of the skills in current program. Knowledge, Attitude and Skills of trainees assessed just before and after the training course based on the material which were used for the training course. K.A.P. changes of two groups were compared by independent t-test, Mann Whitney, Wilcoxon & Chi square. Results: Mean knowledge and skills scores increments were remarkably more significant after attending new course than after passing the current course (P<0.001 and more rehabilitation workers who attending new course use practical guides in addition to verbal instructions to train disabled people and their families (P=0.028. There were no significant differences in attitude changes among the two groups. Conclusion: As trainees learned more by means of the new training course and the two courses were not so different in the resource allocation, substituting the new method to the current one should get consideration.

Labor and birth care by nurse with midwifery skills in Brazil.

Science.gov (United States)

Gama, Silvana Granado Nogueira da; Viellas, Elaine Fernandes; Torres, Jacqueline Alves; Bastos, Maria Helena; Brüggemann, Odaléa Maria; Theme Filha, Mariza Miranda; Schilithz, Arthur Orlando Correa; Leal, Maria do Carmo

2016-10-17

The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections. Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births. 16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower. The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor

Establishing partnership with traditional birth attendants for improved maternal and newborn health: a review of factors influencing implementation.

Science.gov (United States)

Miller, Tina; Smith, Helen

2017-10-19

Recent World Health Organization recommendations recognize the important role Traditional Birth Attendants (TBAs) can play in supporting the health of women and newborns. This paper provides an analysis of key factors that affect the implementation of interventions to develop partnerships with TBAs to promote improved access to skilled care at birth. We conducted a secondary analysis of 20 papers identified through two systematic reviews that examined the effectiveness of interventions to find new roles for TBAs on maternal and newborn health outcomes, as well as papers identified through a systematic mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and implementation barriers and facilitators, as well as other contextual issues. This analysis identified countries that have implemented interventions to support the transition from birth with a TBA to birth with a skilled birth attendant. Drawing on the experiences of these countries, the analysis highlights factors that are important to consider when designing and implementing such interventions. Barriers to implementation included resistance to change in more traditional communities, negative attitudes between TBAs and skilled attendants and TBAs concerns about the financial implications of assuming new roles. Facilitating factors included stakeholder involvement in devising and implementing interventions, knowledge sharing between TBAs and skilled birth attendants, and formalised roles and responsibilities and remuneration for TBAs. The implementation barriers identified in this analysis could, if not addressed, prevent or discourage TBAs from carrying out newly defined roles supporting women in pregnancy and childbirth and linking them to the formal health system. This paper also identifies the factors that seem critical to success, which new programmes could consider adopting

Using community-based participatory research and organizational diagnosis to characterize relationships between community leaders and academic researchers

Directory of Open Access Journals (Sweden)

Karen H. Wang

2017-09-01

Full Text Available Sustaining collaborations between community-based organization leaders and academic researchers in community-engaged research (CEnR in the service of decreasing health inequities necessitates understanding the collaborations from an inter-organizational perspective. We assessed the perspectives of community leaders and university-based researchers conducting community-engaged research in a medium-sized city with a history of community-university tension. Our research team, included experts in CEnR and organizational theory, used qualitative methods and purposeful, snowball sampling to recruit local participants and performed key informant interviews from July 2011–May 2012. A community-based researcher interviewed 11 community leaders, a university-based researcher interviewed 12 university-based researchers. We interviewed participants until we reached thematic saturation and performed analyses using the constant comparative method. Unifying themes characterizing community leaders and university-based researchers' relationships on the inter-organizational level include: 1 Both groups described that community-engaged university-based researchers are exceptions to typical university culture; 2 Both groups described that the interpersonal skills university-based researchers need for CEnR require a change in organizational culture and training; 3 Both groups described skepticism about the sustainability of a meaningful institutional commitment to community-engaged research 4 Both groups described the historical impact on research relationships of race, power, and privilege, but only community leaders described its persistent role and relevance in research relationships. Challenges to community-academic research partnerships include researcher interpersonal skills and different perceptions of the importance of organizational history. Solutions to improve research partnerships may include transforming university culture and community

Effect on postpartum hemorrhage of prophylactic oxytocin (10 IU by injection by community health officers in Ghana: a community-based, cluster-randomized trial.

Directory of Open Access Journals (Sweden)

Cynthia K Stanton

2013-10-01

Full Text Available BACKGROUND: Oxytocin (10 IU is the drug of choice for prevention of postpartum hemorrhage (PPH. Its use has generally been restricted to medically trained staff in health facilities. We assessed the effectiveness, safety, and feasibility of PPH prevention using oxytocin injected by peripheral health care providers without midwifery skills at home births. METHODS AND FINDINGS: This community-based, cluster-randomized trial was conducted in four rural districts in Ghana. We randomly allocated 54 community health officers (stratified on district and catchment area distance to a health facility: ≥10 km versus <10 km to intervention (one injection of oxytocin [10 IU] one minute after birth and control (no provision of prophylactic oxytocin arms. Births attended by a community health officer constituted a cluster. Our primary outcome was PPH, using multiple definitions; (PPH-1 blood loss ≥500 mL; (PPH-2 PPH-1 plus women who received early treatment for PPH; and (PPH-3 PPH-2 plus any other women referred to hospital for postpartum bleeding. Unsafe practice is defined as oxytocin use before delivery of the baby. We enrolled 689 and 897 women, respectively, into oxytocin and control arms of the trial from April 2011 to November 2012. In oxytocin and control arms, respectively, PPH-1 rates were 2.6% versus 5.5% (RR: 0.49; 95% CI: 0.27-0.88; PPH-2 rates were 3.8% versus 10.8% (RR: 0.35; 95% CI: 0.18-0.63, and PPH-3 rates were similar to those of PPH-2. Compared to women in control clusters, those in the intervention clusters lost 45.1 mL (17.7-72.6 less blood. There were no cases of oxytocin use before delivery of the baby and no major adverse events requiring notification of the institutional review boards. Limitations include an unblinded trial and imbalanced numbers of participants, favoring controls. CONCLUSION: Maternal health care planners can consider adapting this model to extend the use of oxytocin into peripheral settings including, in some

A study of the effect of training pregnant women about attachment skills on infants’ motor development indices at birth to four months

Directory of Open Access Journals (Sweden)

Akram Dokuhaki

2017-06-01

Full Text Available Background. During pregnancy fetus-maternal attachment can improve maternal-fetal attachment, and have positive effects on the infant’s growth and development. Objectives. This study aimed to investigate the effect of training pregnant mothers about attachment skills on infants’ motor development indices at birth to four months. Material and methods. This study is a clinical trial with convenient sampling on 190 pregnant women in Hafez hospital. They were randomly divided into two groups: intervention and control. There were 94 and 96 patients in the control and intervention groups, respectively. In the intervention group, 6 sessions of 90-minute educational classes were held. After birth, the infants were compared, in both groups, in terms of motor status using the Denver questionnaire at birth to the age of 4 months. Results . In the intervention group, educating the women on fetal-maternal attachment skills was associated with infants’ earlier achievement age in terms of some gross motor, all fields of speech-language, and one item of fine-adaptive motor realms. In addition, the infants’ age was significantly reduced in achieving some personal-social items, as well as gross-fine scope at one and three months. Conclusions . Training the mothers in attachment skills increased fetal-maternal attachment and improved the motor development indicators in infants aged up to four months. Therefore, training in attachment skills is recommended to be given as a component of routine pregnancy care.

Community Living Skills Guide: Cooking/Food Preparation.

Science.gov (United States)

Nickovich, Marti; Kreps, Alice Roelofs

One of twenty course guides in the Community Living Skills Guide for the College for Living series, this document provides guidelines and workbook activities for the course, Cooking/Food Preparation. The series of courses for developmentally disabled adults is intended to supplement residential programs and to aid in orienting institutionalized…

Coverage of private sector community midwife services in rural Punjab, Pakistan: development and demand.

Science.gov (United States)

Mumtaz, Zubia; Levay, Adrienne V; Jhangri, Gian S; Bhatti, Afshan

2015-11-25

In 2007, the Government of Pakistan introduced a new cadre of community midwives (CMWs) to address low skilled birth attendance rates in rural areas; this workforce is located in the private-sector. There are concerns about the effectiveness of the programme for increasing skilled birth attendance as previous experience from private-sector programmes has been sub-optimal. Indonesia first promoted private sector midwifery care, but the initiative failed to provide universal coverage and reduce maternal mortality rates. A clustered, stratified survey was conducted in the districts of Jhelum and Layyah, Punjab. A total of 1,457 women who gave birth in the 2 years prior to the survey were interviewed. χ(2) analyses were performed to assess variation in coverage of maternal health services between the two districts. Logistic regression models were developed to explore whether differentials in coverage between the two districts could be explained by differential levels of development and demand for skilled birth attendance. Mean cost of childbirth care by type of provider was also calculated. Overall, 7.9% of women surveyed reported a CMW-attended birth. Women in Jhelum were six times more likely to report a CMW-attended birth than women in Layyah. The mean cost of a CMW-attended birth compared favourably with a dai-attended birth. The CMWs were, however, having difficulty garnering community trust. The majority of women, when asked why they had not sought care from their neighbourhood CMW, cited a lack of trust in CMWs' competency and that they wanted a different provider. The CMWs have yet to emerge as a significant maternity care provider in rural Punjab. Levels of overall community development determined uptake and hence coverage of CMW care. The CMWs were able to insert themselves into the maternal health marketplace in Jhelum because of an existing demand. A lower demand in Layyah meant there was less 'space' for the CMWs to enter the market. To ensure universal

Influence of culture and community perceptions on birth and perinatal care of immigrant women: doulas' perspective.

Science.gov (United States)

Kang, Hye-Kyung

2014-01-01

A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women's birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended.

Developing the Oral Skill in Online English Courses Framed by the Community of Inquiry

Directory of Open Access Journals (Sweden)

Luz Edith Herrera Díaz

2017-01-01

Full Text Available Over the last decade, the community of inquiry framework has proved successful for online learning experiences in diverse disciplines, although studies in the teaching of English as a foreign language arena are still scarce. In this vein, this article reports a preliminary study about the development of the oral skill in a Basic English online course, uncovering the relationship between the community of inquiry framework (with its three forms of presence: teaching, cognitive, and social and some indicators of the oral skill. Findings, based on learners’ perceptions, confirmed the existence of such framework and suggest that the teaching presence fosters grammar, accuracy, and vocabulary. Discussion of findings, limitations of the study and future possible research actions conclude this report.

Results from the Data & Democracy initiative to enhance community-based organization data and research capacity.

Science.gov (United States)

Carroll-Scott, Amy; Toy, Peggy; Wyn, Roberta; Zane, Jazmin I; Wallace, Steven P

2012-07-01

In an era of community-based participatory research and increased expectations for evidence-based practice, we evaluated an initiative designed to increase community-based organizations' data and research capacity through a 3-day train-the-trainer course on community health assessments. We employed a mixed method pre-post course evaluation design. Various data sources collected from 171 participants captured individual and organizational characteristics and pre-post course self-efficacy on 19 core skills, as well as behavior change 1 year later among a subsample of participants. Before the course, participants reported limited previous experience with data and low self-efficacy in basic research skills. Immediately after the course, participants demonstrated statistically significant increases in data and research self-efficacy. The subsample reported application of community assessment skills to their work and increased use of data 1 year later. Results suggest that an intensive, short-term training program can achieve large immediate gains in data and research self-efficacy in community-based organization staff. In addition, they demonstrate initial evidence of longer-term behavior change related to use of data and research skills to support their community work.

Community social capital on the timing of sexual debut and teen birth in Nicaragua: a multilevel approach.

Science.gov (United States)

Mendez Rojas, Bomar; Beogo, Idrissa; Owili, Patrick Opiyo; Adesanya, Oluwafunmilade; Chen, Chuan-Yu

2016-09-15

Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America. Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network). Higher prevalence of female sexual debut (norms) and higher proportion of secondary school or higher education (resource) in the community are associated with an earlier age of sexual debut by 47 % (p teen birth (p teen childbearing (p teen-onset sex and birth. The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process.

The return of the Traditional Birth Attendant

Directory of Open Access Journals (Sweden)

Karen Lane

2016-12-01

Full Text Available Sub–Saharan Africa and Southern Asia lag behind other regions in the provision of antenatal care and skilled attendance at birth (although typically attended by a family member or villager and over 32 million of the 40 million births not attended by skilled health personnel in 2012 occurred in rural areas. Overall, one–quarter of women in developing nations still birth alone or with a relative to assist them.

Community-based research in action: tales from the Ktunaxa community learning centres project.

Science.gov (United States)

Stacy, Elizabeth; Wisener, Katherine; Liman, Yolanda; Beznosova, Olga; Lauscher, Helen Novak; Ho, Kendall; Jarvis-Selinger, Sandra

2014-01-01

Rural communities, particularly Aboriginal communities, often have limited access to health information, a situation that can have significant negative consequences. To address the lack of culturally and geographically relevant health information, a community-university partnership was formed to develop, implement, and evaluate Aboriginal Community Learning Centres (CLCs). The objective of this paper is to evaluate the community-based research process used in the development of the CLCs. It focuses on the process of building relationships among partners and the CLC's value and sustainability. Semistructured interviews were conducted with key stakeholders, including principal investigators, community research leads, and supervisors. The interview transcripts were analyzed using an open-coding process to identify themes. Key challenges included enacting shared project governance, negotiating different working styles, and hiring practices based on commitment to project objectives rather than skill set. Technological access provided by the CLCs increased capacity for learning and collective community initiatives, as well as building community leads' skills, knowledge, and self-efficacy. An important lesson was to meet all partners "where they are" in building trusting relationships and adapting research methods to fit the project's context and strengths. Successful results were dependent upon persistence and patience in working through differences, and breaking the project into achievable goals, which collectively contributed to trust and capacity building. The process of building these partnerships resulted in increased capacity of communities to facilitate learning and change initiatives, and the capacity of the university to engage in successful research partnerships with Aboriginal communities in the future.

A communication skills intervention for community healthcare workers reduces perceived patient aggression: a pretest-postest study.

Science.gov (United States)

Swain, Nicola; Gale, Christopher

2014-09-01

Previous studies have shown that healthcare workers experience high levels of aggression from patients. Prevention packages to address this have received little research support. Communication skills have been shown to influence individuals' experience of aggression and are also amenable to training. This study aims to deliver a communication skills training package that will reduce the experience of aggression in the workplace for healthcare workers. An interactive, multimedia communication skills package was developed that would be suitable for community healthcare workers. The training consisted of four workshops, including teaching, discussion and DVD illustrative examples. These were based on research and clinical experience. This intervention was delivered in two community care organisations over several months. Fifty-six community healthcare workers took part in the trial in small groups. There were 46 females and 10 males with a median age of 45-54 years. For each group a series of four communication skills workshops were given. Measurements of perceived aggression and wellbeing were taken before the workshops, at the end of the workshops, one month after and two months after. Results show statistically significant reductions in perceived aggression one and two months after baseline measures (pcommunication skills training programme is both enjoyable and shows decreases in perceived aggression, distress, and increases in general mental wellness. A full RCT of this intervention is warranted. Copyright © 2014 Elsevier Ltd. All rights reserved.

Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

Directory of Open Access Journals (Sweden)

Fisseha G

2017-10-01

Full Text Available Girmatsion Fisseha,1 Yemane Berhane,2 Alemayehu Worku,2,3 Wondwossen Terefe1 1Mekelle University, College of Health Science, School of Public Health, Mekelle, Ethiopia; 2Addis Continental Institute of Public Health, Epidemiology Department, Addis Ababa, Ethiopia; 3Addis Ababa University, School of Public Health, Biostatistics Department, Addis Ababa, Ethiopia Background: Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia.Subjects and methods: A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR and 95% confidence interval (CI.Results: A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71], perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13], experiencing any complication during childbirth, using antenatal care, lower

Social attribution skills of children born preterm at very low birth weight.

Science.gov (United States)

Williamson, Kathryn E; Jakobson, Lorna S

2014-11-01

Children born prematurely at very low birth weight (social functioning, including autism spectrum disorders (e.g., Johnson et al., 2010). In the current study, we used the Happé-Frith animated triangles task (Abell, Happé, & Frith, 2000) to study social attribution skills in this population. In this task, typical viewers attribute intentionality and mental states to shapes, based on characteristics of their movements. Participants included 34 preterm children and 36 full-term controls, aged 8-11 years. Groups were comparable in terms of age at test, gender, handedness, and socioeconomic status; they also performed similarly on tests of selective attention/processing speed and verbal intelligence. Relative to full-term peers, preterm children's descriptions of the animations were less appropriate overall; they also overattributed intentionality/mental states to randomly moving shapes and underattributed intentionality/mental states to shapes that seemed to be interacting socially. Impairments in the ability to infer the putative mental states of triangles from movement cues alone were most evident in children displaying more "autistic-like" traits, and this may reflect atypical development of and/or functioning in, or atypical connections between, parts of the social brain.

Influence of Culture and Community Perceptions on Birth and Perinatal Care of Immigrant Women: Doulas’ Perspective

Science.gov (United States)

Kang, Hye-Kyung

2014-01-01

A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women’s birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended. PMID:24453465

Identification of Important Community Living Skills for Adults with Mental Retardation.

Science.gov (United States)

Lovett, David L.; Harris, Mary B.

1987-01-01

Attempted to identify skills important for successful community living of adults with mental retardation. Individuals (N=73) who had significant contact with adults with mental retardation completed questionnaire on academic, leisure, personal, social, and vocational skills frequently taught to persons with mental handicaps. Subjects considered…

Prospective study of determinants and costs of home births in Mumbai slums

Directory of Open Access Journals (Sweden)

Das Sushmita

2010-07-01

Full Text Available Abstract Background Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth. Methods As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models. Results We described 1708 (16% home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai, and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location. Conclusions We estimate 32 000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be

Birth weight and special educational needs: results of a population-based study in Berlin.

Science.gov (United States)

Bettge, Susanne; Oberwöhrmann, Sylke; Brockstedt, Matthias; Bührer, Christoph

2014-05-09

Preterm infants are at higher risk for developmental problems. The aim of this study is to quantify the relation between birth weight and special educational needs. We analyzed data from the pre-school examinations of 134 313 children in Berlin aged 5 to 6 who were examined between 2007 and 2011. Special educational needs were diagnosed in 8058 children (6.0%), 4943 (61%) of whom had weighed 3000 g or more at birth. The percentage of children with special educational needs rose steadily with decreasing birth weight (2250-2499 g, 9.2%; 1250-1499 g, 21.1%; less than 750 g, 35.6%). Logistic regression analysis yielded odds ratios and 99% confidence intervals for special educational needs that ranged from 1.32 [1.17-1.47] for birth weight 2750-2999 g to 12.83 [7.48-22.03] for birth weight less than 750 g. Further risk factors were male sex (1.88 [1.75-2.03]), low social status (5.96 [5.21-6.82]), an immigrant background associated with poor German language skills in the family (1.63 [1.43-1.86]), and being raised by a single parent (1.21 [1.12-1.31]). On the other hand, nursery school and/or kindergarten enrollment for at least two years before entering school (0.82 [0.73-0.91]) and an immigrant background with good German skills in the family (0.39 [0.34-0.45]) were associated with lower rates of special educational needs. The risk of special educational needs increases already with moderately decreased birth weight. The most important factor other than birth weight is the family's social status. Although children of very low birth weight have a much higher rate of special educational needs than other children, they still make up only a small percentage of all children with special educational needs.

Accelerated Training of Skilled Birth Attendants in a Marginalized Population on the Thai-Myanmar Border: A Multiple Methods Program Evaluation.

Science.gov (United States)

White, Adrienne Lynne; Min, Thaw Htwe; Gross, Mechthild M; Kajeechiwa, Ladda; Thwin, May Myo; Hanboonkunupakarn, Borimas; Than, Hla Hla; Zin, Thet Wai; Rijken, Marcus J; Hoogenboom, Gabie; McGready, Rose

2016-01-01

To evaluate a skilled birth attendant (SBA) training program in a neglected population on the Thai-Myanmar border, we used multiple methods to show that refugee and migrant health workers can be given effective training in their own environment to become SBAs and teachers of SBAs. The loss of SBAs through resettlement to third countries necessitated urgent training of available workers to meet local needs. All results were obtained from student records of theory grades and clinical log books. Qualitative evaluation of both the SBA and teacher programs was obtained using semi-structured interviews with supervisors and teachers. We also reviewed perinatal indicators over an eight-year period, starting prior to the first training program until after the graduation of the fourth cohort of SBAs. Four SBA training programs scheduled between 2009 and 2015 resulted in 79/88 (90%) of students successfully completing a training program of 250 theory hours and 625 supervised clinical hours. All 79 students were able to: achieve pass grades on theory examination (median 80%, range [70-89]); obtain the required clinical experience within twelve months; achieve clinical competence to provide safe care during childbirth. In 2010-2011, five experienced SBAs completed a train-the-trainer (TOT) program and went on to facilitate further training programs. Perinatal indicators within Shoklo Malaria Research Unit (SMRU), such as place of birth, maternal and newborn outcomes, showed no significant differences before and after introduction of training or following graduate deployment in the local maternity units. Confidence, competence and teamwork emerged from qualitative evaluation by senior SBAs working with and supervising students in the clinics. We demonstrate that in resource-limited settings or in marginalized populations, it is possible to accelerate training of skilled birth attendants to provide safe maternity care. Education needs to be tailored to local needs to ensure

Exploring the bovine rumen bacterial community from birth to adulthood.

Science.gov (United States)

Jami, Elie; Israel, Adi; Kotser, Assaf; Mizrahi, Itzhak

2013-06-01

The mammalian gut microbiota is essential in shaping many of its host's functional attributes. One such microbiota resides in the bovine digestive tract in a compartment termed as the rumen. The rumen microbiota is necessary for the proper physiological development of the rumen and for the animal's ability to digest and convert plant mass into food products, making it highly significant to humans. The establishment of this microbial population and the changes occurring with the host's age are important for understanding this key microbial community. Despite its importance, little information about colonization of the microbial populations in newborn animals, and the gradual changes occurring thereafter, exists. Here, we characterized the overall bovine ruminal bacterial populations of five age groups, from 1-day-old calves to 2-year-old cows. We describe the changes occurring in the rumen ecosystem after birth, reflected by a decline in aerobic and facultative anaerobic taxa and an increase in anaerobic ones. Some rumen bacteria that are essential for mature rumen function could be detected as early as 1 day after birth, long before the rumen is active or even before ingestion of plant material occurs. The diversity and within-group similarity increased with age, suggesting a more diverse but homogeneous and specific mature community, compared with the more heterogeneous and less diverse primary community. In addition, a convergence toward a mature bacterial arrangement with age was observed. These findings have also been reported for human gut microbiota, suggesting that similar forces drive the establishment of gut microbiotas in these two distinct mammalian digestive systems.

Improving Maternal and Child Healthcare Programme Using Community-Participatory Interventions in Ebonyi State Nigeria

Directory of Open Access Journals (Sweden)

Chigozie Jesse Uneke

2014-10-01

Full Text Available In Nigeria, the government is implementing the Free Maternal and Child Health Care Programme (FMCHCP. The policy is premised on the notion that financial barriers are one of the most important constraints to equitable access and use of skilled maternal and child healthcare. In Ebonyi State, Southeastern Nigeria the FMCHCP is experiencing implementation challenges including: inadequate human resource for health, inadequate funding, out of stock syndrome, inadequate infrastructure, and poor staff remuneration. Furthermore, there is less emphasis on community involvement in the programme implementation. In this policy brief, we recommend policy options that emphasize the implementation of community-based participatory interventions to strengthen the government’s FMCHCP as follows: Option 1: Training community women on prenatal care, life-saving skills in case of emergency, reproductive health, care of the newborn and family planning. Option 2: Sensitizing the community women towards behavioural change, to understand what quality services that respond to their needs are but also to seek and demand for such. Option 3: Implementation packages that provide technical skills to women of childbearing age as well as mothers’ groups, and traditional birth attendants for better home-based maternal and child healthcare. The effectiveness of this approach has been demonstrated in a number of community-based participatory interventions, building on the idea that if community members take part in decision-making and bring local knowledge, experiences and problems to the fore, they are more likely to own and sustain solutions to improve their communities’ health.

Community social capital on the timing of sexual debut and teen birth in Nicaragua: a multilevel approach

Directory of Open Access Journals (Sweden)

Bomar Mendez Rojas

2016-09-01

Full Text Available Abstract Background Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America. Methods Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network. Results Higher prevalence of female sexual debut (norms and higher proportion of secondary school or higher education (resource in the community are associated with an earlier age of sexual debut by 47 % (p < 0.05 and 16 %, respectively (p < 0.001. Living in a community with a high proportion of females having a child increases the hazard of teen birth (p < 0.001 and resource is negatively associated with teen childbearing (p < 0.05. Residential stability and community religious composition (social network were not linked with teen-onset sex and birth. Conclusions The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process.

Post-neonatal mortality, morbidity, and developmental outcome after ultrasound-dated preterm birth in rural Malawi: a community-based cohort study.

Directory of Open Access Journals (Sweden)

Melissa Gladstone

2011-11-01

Full Text Available Preterm birth is considered to be associated with an estimated 27% of neonatal deaths, the majority in resource-poor countries where rates of prematurity are high. There is no information on medium term outcomes after accurately determined preterm birth in such settings.This community-based stratified cohort study conducted between May-December 2006 in Southern Malawi followed up 840 post-neonatal infants born to mothers who had received antenatal antibiotic prophylaxis/placebo in an attempt to reduce rates of preterm birth (APPLe trial ISRCTN84023116. Gestational age at delivery was based on ultrasound measurement of fetal bi-parietal diameter in early-mid pregnancy. 247 infants born before 37 wk gestation and 593 term infants were assessed at 12, 18, or 24 months. We assessed survival (death, morbidity (reported by carer, admissions, out-patient attendance, growth (weight and height, and development (Ten Question Questionnaire [TQQ] and Malawi Developmental Assessment Tool [MDAT]. Preterm infants were at significantly greater risk of death (hazard ratio 1.79, 95% CI 1.09-2.95. Surviving preterm infants were more likely to be underweight (weight-for-age z score; p<0.001 or wasted (weight-for-length z score; p<0.01 with no effect of gestational age at delivery. Preterm infants more often screened positively for disability on the Ten Question Questionnaire (p = 0.002. They also had higher rates of developmental delay on the MDAT at 18 months (p = 0.009, with gestational age at delivery (p = 0.01 increasing this likelihood. Morbidity-visits to a health centre (93% and admissions to hospital (22%-was similar for both groups.During the first 2 years of life, infants who are born preterm in resource poor countries, continue to be at a disadvantage in terms of mortality, growth, and development. In addition to interventions in the immediate neonatal period, a refocus on early childhood is needed to improve outcomes for infants born preterm

Niyith NiyithWatmam [corrected] (the quiet story): exploring the experiences of Aboriginal women who give birth in their remote community.

Science.gov (United States)

Ireland, Sarah; Wulili Narjic, Concepta; Belton, Suzanne; Kildea, Sue

2011-10-01

to investigate the beliefs and practices of Aboriginal women who decline transfer to urban hospitals and remain in their remote community to give birth. an ethnographic approach was used which included: the collection of birth histories and narratives, observation and participation in the community for 24 months, field notes, training and employment of an Aboriginal co-researcher, and consultation with and advice from a local reference group. a remote Aboriginal community in the Northern Territory, Australia. narratives were collected from seven Aboriginal women and five family members. findings showed that women, through their previous experiences of standard care, appeared to make conscious decisions and choices about managing their subsequent pregnancies and births. Women took into account their health, the baby's health, the care of their other children, and designated men with a helping role. narratives described a breakdown of traditional birthing practices and high levels of non-compliance with health-system-recommended care. standard care provided for women relocating for birth must be improved, and the provision of a primary maternity service in this particular community may allow Aboriginal Women's Business roles and cultural obligations to be recognised and invigorated. International examples of primary birthing services in remote areas demonstrate that they can be safe alternatives to urban transfer for childbirth. A primary maternity service would provide a safer environment for the women who choose to avoid standard care. Copyright © 2010 Elsevier Ltd. All rights reserved.

Utilization of the state led public private partnership program "Chiranjeevi Yojana" to promote facility births in Gujarat, India: a cross sectional community based study.

Science.gov (United States)

Yasobant, Sandul; Vora, Kranti Suresh; Shewade, Hemant Deepak; Annerstedt, Kristi Sidney; Isaakidis, Petros; Mavalankar, Dileep V; Dholakia, Nishith B; De Costa, Ayesha

2016-07-15

"Chiranjeevi Yojana (CY)", a state-led large-scale demand-side financing scheme (DSF) under public-private partnership to increase institutional delivery, has been implemented across Gujarat state, India since 2005. The scheme aims to provide free institutional childbirth services in accredited private health facilities to women from socially disadvantaged groups (eligible women). These services are paid for by the state to the private facility with the intention of service being free to the user. This community-based study estimates CY uptake among eligible women and explores factors associated with non-utilization of the CY program. This was a community-based cross sectional survey of eligible women who gave birth between January and July 2013 in 142 selected villages of three districts in Gujarat. A structured questionnaire was administered by trained research assistant to collect information on socio-demographic details, pregnancy details, details of childbirth and out-of-pocket (OOP) expenses incurred. A multivariable inferential analysis was done to explore the factors associated with non-utilization of the CY program. Out of 2,143 eligible women, 559 (26 %) gave birth under the CY program. A further 436(20 %) delivered at free public facilities, 713(33 %) at private facilities (OOP payment) and 435(20 %) at home. Eligible women who belonged to either scheduled tribe or poor [aOR = 3.1, 95 % CI:2.4 - 3.8] or having no formal education [aOR = 1.6, 95 % CI:1.1, 2.2] and who delivered by C-section [aOR = 2.1,95 % CI: 1.2, 3.8] had higher odds of not utilizing CY program. Of births at CY accredited facilities (n = 924), non-utilization was 40 % (n = 365) mostly because of lack of required official documentation that proved eligibility (72 % of eligible non-users). Women who utilized the CY program overall paid more than women who delivered in the free public facilities. Uptake of the CY among eligible women was low after almost a decade

Factors affecting development of motor skills in extremely low birth weight children.

Science.gov (United States)

O'Connor, Anna R; Birch, Eileen E; Spencer, Rand

2009-01-01

The aim of this study is to analyze the impact of ophthalmic and neonatal factors on motor development in extremely low birth weight (ELBW) children. Sixty-four ELBW children at least 3 years of age were recruited. Visual acuity (VA) was assessed using the Teller acuity cards (TACs) and a letter test, if possible. A validated questionnaire assessing 25 fine (part A) and 20 gross motor (part B) skills was administered to the parents. Data were collected on retinopathy of prematurity (ROP) zone, intraventricular haemorrhage (IVH), length of stay in hospital, and number of days on oxygen. Abnormal TAC acuity was associated with significantly lower scores on both parts A and B (part A: 21.5 versus 11.8, p development, particularly fine motor development.

An assessment of the impact of entrepreneurial skills of community pharmacists on pharmaceutical business performance in Jos metropolis, Nigeria

Science.gov (United States)

Nmadu, Teresa M.

2018-01-01

Background: Community pharmacy has been a lucrative area of practice for pharmacists in Jos, Nigeria, until about the turn of the millennium where a decline in viability of the business has been observed. Objective: This study assessed the entrepreneurial skills of community pharmacists, the business performance of community pharmacies and the impact of their entrepreneurial skills on business performance. Methods: A cross sectional survey was conducted by administering a pretested questionnaire to 30 community pharmacists in Jos. An adaptation of the Bernelli model and the expanded Katz (1974)/Herron (1990) Skill Typology Model was used to assess nine entrepreneurial skills - product, organizational, industry, networking, leadership, executive, entrepreneurial, marketing and money skills; while sales growth, net profit and stock growth were used to assess business performance. Frequency distribution of results was presented, with further analysis done with the Epi-Info software using the chi square test of association. Result: The results from this study showed that community pharmacies in Jos do possess requisite entrepreneurial skills, but to varying extents. Product skills ranked highest while money skills and entrepreneurial skills ranked least, portraying a need for skills enhancement in these areas. Business performance was suboptimal, being rated as average or poor by 56.6% of respondents. However, most respondents (90%) still assessed their businesses as profitable. Money skills had a significant impact on business performance (P=0.03) and stock growth (P=0.04); while stock growth was significantly affected by leadership skills (P=0.002) and entrepreneurial skills (0.02). Net profit was significantly affected by industry skills (P=0.008). Conclusions: Community pharmacy business is still a profitable business venture in Jos though business performance is sub optimal. The entrepreneurial skills set of a community pharmacist set has an impact on business

An assessment of the impact of entrepreneurial skills of community pharmacists on pharmaceutical business performance in Jos metropolis, Nigeria.

Science.gov (United States)

Asieba, Iyeseun O; Nmadu, Teresa M

2018-01-01

Community pharmacy has been a lucrative area of practice for pharmacists in Jos, Nigeria, until about the turn of the millennium where a decline in viability of the business has been observed. This study assessed the entrepreneurial skills of community pharmacists, the business performance of community pharmacies and the impact of their entrepreneurial skills on business performance. A cross sectional survey was conducted by administering a pretested questionnaire to 30 community pharmacists in Jos. An adaptation of the Bernelli model and the expanded Katz (1974)/Herron (1990) Skill Typology Model was used to assess nine entrepreneurial skills - product, organizational, industry, networking, leadership, executive, entrepreneurial, marketing and money skills; while sales growth, net profit and stock growth were used to assess business performance. Frequency distribution of results was presented, with further analysis done with the Epi-Info software using the chi square test of association. The results from this study showed that community pharmacies in Jos do possess requisite entrepreneurial skills, but to varying extents. Product skills ranked highest while money skills and entrepreneurial skills ranked least, portraying a need for skills enhancement in these areas. Business performance was suboptimal, being rated as average or poor by 56.6% of respondents. However, most respondents (90%) still assessed their businesses as profitable. Money skills had a significant impact on business performance (P=0.03) and stock growth (P=0.04); while stock growth was significantly affected by leadership skills (P=0.002) and entrepreneurial skills (0.02). Net profit was significantly affected by industry skills (P=0.008). Community pharmacy business is still a profitable business venture in Jos though business performance is sub optimal. The entrepreneurial skills set of a community pharmacist set has an impact on business performance with money skills, leadership skills and

An assessment of the impact of entrepreneurial skills of community pharmacists on pharmaceutical business performance in Jos metropolis, Nigeria

Directory of Open Access Journals (Sweden)

Asieba IO

2018-03-01

Full Text Available Background: Community pharmacy has been a lucrative area of practice for pharmacists in Jos, Nigeria, until about the turn of the millennium where a decline in viability of the business has been observed. Objective: This study assessed the entrepreneurial skills of community pharmacists, the business performance of community pharmacies and the impact of their entrepreneurial skills on business performance. Methods: A cross sectional survey was conducted by administering a pretested questionnaire to 30 community pharmacists in Jos. An adaptation of the Bernelli model and the expanded Katz (1974/Herron (1990 Skill Typology Model was used to assess nine entrepreneurial skills - product, organizational, industry, networking, leadership, executive, entrepreneurial, marketing and money skills; while sales growth, net profit and stock growth were used to assess business performance. Frequency distribution of results was presented, with further analysis done with the Epi-Info software using the chi square test of association. Result: The results from this study showed that community pharmacies in Jos do possess requisite entrepreneurial skills, but to varying extents. Product skills ranked highest while money skills and entrepreneurial skills ranked least, portraying a need for skills enhancement in these areas. Business performance was suboptimal, being rated as average or poor by 56.6% of respondents. However, most respondents (90% still assessed their businesses as profitable. Money skills had a significant impact on business performance (P=0.03 and stock growth (P=0.04; while stock growth was significantly affected by leadership skills (P=0.002 and entrepreneurial skills (0.02. Net profit was significantly affected by industry skills (P=0.008. Conclusions: Community pharmacy business is still a profitable business venture in Jos though business performance is sub optimal. The entrepreneurial skills set of a community pharmacist set has an impact on

Piloting community-based medical care for survivors of sexual assault in conflict-affected Karen State of eastern Burma.

Science.gov (United States)

Tanabe, Mihoko; Robinson, Keely; Lee, Catherine I; Leigh, Jen A; Htoo, Eh May; Integer, Naw; Krause, Sandra K

2013-05-21

Given the challenges to ensuring facility-based care in conflict settings, the Women's Refugee Commission and partners have been pursuing a community-based approach to providing medical care to survivors of sexual assault in Karen State, eastern Burma. This new model translates the 2004 World Health Organization's Clinical Management of Rape Survivors facility-based protocol to the community level through empowering community health workers to provide post-rape care. The aim of this innovative study is to examine the safety and feasibility of community-based medical care for survivors of sexual assault to contribute to building an evidence base on alternative models of care in humanitarian settings. A process evaluation was implemented from July-October 2011 to gather qualitative feedback from trained community health workers, traditional birth attendants, and community members. Two focus group discussions were conducted among the highest cadre health care workers from the pilot and non-pilot sites. In Karen State, eight focus group discussions were convened among traditional birth attendants and 10 among women and men of reproductive age. Qualitative feedback contributed to an understanding of the model's feasibility. Pilot site community health workers showed interest in providing community-based care for survivors of sexual assault. Traditional birth attendants attested to the importance of making this care available. Community health workers were deeply aware of the need to maintain confidentiality and offer compassionate care. They did not raise safety as an excess concern in the provision of treatment. Data speak to the promising "feasibility" of community-based post-rape care. More time, awareness-raising, and a larger catchment population are necessary to answer the safety perspective. The pilot is an attempt to translate facility-based protocol to the community level to offer solutions for settings where traditional methods of post-rape care are not

Increasing Access to Prevention of Postpartum Hemorrhage Interventions for Births in Health Facilities and at Home in Four Districts of Rwanda.

Science.gov (United States)

Dao, Blami; Ngabo, Fidele; Zoungrana, Jeremie; Rawlins, Barbara; Mukarugwiro, Beata; Musoni, Pascal; Favero, Rachel; MacDowell, Juliet; Eugene, Kanyamanza

2015-12-01

To assess coverage, acceptability, and feasibility of a program to prevent postpartum hemorrhage (PPH) at community and facility levels, a study was conducted in 60 health facilities and their catchment areas in four districts in Rwanda. A total of 220 skilled birth attendants at these facilities were trained to provide active management of the third stage of labor and 1994 community health workers (ASMs) were trained to distribute misoprostol at home births. A total of 4,074 pregnant women were enrolled in the program (20.5% of estimated deliveries). Overall uterotonic coverage was 82.5%: 85% of women who delivered at a facility received a uterotonic to prevent PPH; 76% of women reached at home at the time of birth by an ASM ingested misoprostol--a 44.3% coverage rate. Administration of misoprostol at the time of birth for home births achieved moderate uterotonic coverage. Advancing the distribution of misoprostol through antenatal care services could further increase coverage.

Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis.

Science.gov (United States)

Worku, Abebaw Gebeyehu; Yalew, Alemayehu Worku; Afework, Mesganaw Fantahun

2013-04-15

The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve "kebeles" of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Factors operating at individual and "kebele" levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about

Factors that determine the use of skilled care during delivery in India: implications for achievement of MDG-5 targets.

Science.gov (United States)

Hazarika, Indrajit

2011-11-01

The objective of this study is to identify individual level factors that determine the use of skilled birth attendants in India. Data from the cross-sectional, population-based NFHS 3 Survey 2005-06 was used. A sample of 31,797 women, aged 15-49 years, who gave births in the 3 months preceding the survey and for whom information was available on most variables, were included in the analysis. Both bivariate and multivariate techniques were used to determine factors associated with the use of skilled attendants at birth. In the study we found that wealth is one of the strongest determinants of skilled birth attendant use, with the poor being at a disadvantage. There are significant differences in the use of skilled delivery care among the urban and rural populations in India. Women in urban areas are more likely to use skilled attendants. Muslim women and women with lower levels of education are also less likely to avail skilled delivery services. The use of skilled care depended significantly on the place of delivery. Women who gave history of antenatal visits were more likely to have skilled attendants at birth. Our analysis demonstrates that there are several financial, social, regional and cultural barriers to skilled birth attendant use in India. Effective strategies need to be planned to generate demand for skilled birth attendants and reduce barriers to care seeking, especially among rural poor.

Training community matrons in basic cognitive behavioural therapy-based techniques for patients with COPD.

Science.gov (United States)

Barker, David; Davies, Caroline; Dixon, Brendan; Hodgson, Amanda; Reay, Simon; Barclay, Nicola

2014-06-01

People with chronic obstructive pulmonary disease (COPD) experience anxiety and depression with a higher prevalence than the general population. Despite this, they are under-represented in mental health services on a national scale, but do regularly have contact with health-care professionals such as community matrons. We aimed to explore the process of CBT-based skills supervision and the practical implications for community matrons using CBT-based techniques with COPD clients as part of their standard practice. Twenty community matrons took part in a 2-day CBT-based skills training programme. Measurements of their knowledge and understanding of CBT-based skills were taken before and following the training. Additionally, they completed written feedback relating to the training. They were then supervised by CBT therapists for 6 months. Written feedback was obtained following this and some supervisors participated in a 1-hour focus group to discuss the process. Community matrons' knowledge and understanding of CBT-based techniques significantly improved following training, although findings did indicate that merely training did not always seamlessly translate into effective practice. Supervisor feedback suggested that it would be beneficial for community matrons to share positive practice of their use of basic CBT-based techniques among peers to maximise the perceived value of this approach.

Familia and Comunidad-Based Saberes: Learning in an Indigenous Heritage Community

Science.gov (United States)

Urrieta, Luis, Jr.

2013-01-01

This article explores how children and youth learned indigenous heritage "saberes" (knowings) through intent community participation in Nocutzepo, Mexico. The "familia" (family) and "comunidad" (community)-based saberes were valuable for skills acquisition, but most important for learning indigenous forms of…

Differences between Girls and Boys in Emerging Language Skills: Evidence from 10 Language Communities

Science.gov (United States)

Eriksson, Marten; Marschik, Peter B.; Tulviste, Tiia; Almgren, Margareta; Perez Pereira, Miguel; Wehberg, Sonja; Marjanovic-Umek, Ljubica; Gayraud, Frederique; Kovacevic, Melita; Gallego, Carlos

2012-01-01

The present study explored gender differences in emerging language skills in 13,783 European children from 10 non-English language communities. It was based on a synthesis of published data assessed with adapted versions of the MacArthur-Bates Communicative Development Inventories (CDIs) from age 0.08 to 2.06. The results showed that girls are…

Fundamental movement skills and physical activity among children living in low-income communities: a cross-sectional study.

Science.gov (United States)

Cohen, Kristen E; Morgan, Philip J; Plotnikoff, Ronald C; Callister, Robin; Lubans, David R

2014-04-08

Although previous studies have demonstrated that children with high levels of fundamental movement skill competency are more active throughout the day, little is known regarding children's fundamental movement skill competency and their physical activity during key time periods of the school day (i.e., lunchtime, recess and after-school). The purpose of this study was to examine the associations between fundamental movement skill competency and objectively measured moderate-to-vigorous physical activity (MVPA) throughout the school day among children attending primary schools in low-income communities. Eight primary schools from low-income communities and 460 children (8.5 ± 0.6 years, 54% girls) were involved in the study. Children's fundamental movement skill competency (TGMD-2; 6 locomotor and 6 object-control skills), objectively measured physical activity (ActiGraph GT3X and GT3X + accelerometers), height, weight and demographics were assessed. Multilevel linear mixed models were used to assess the cross-sectional associations between fundamental movement skills and MVPA. After adjusting for age, sex, BMI and socio-economic status, locomotor skill competency was positively associated with total (P=0.002, r=0.15) and after-school (P=0.014, r=0.13) MVPA. Object-control skill competency was positively associated with total (Pskill competency appears to be a better predictor of children's MVPA during school-based physical activity opportunities than locomotor skill competency. Improving fundamental movement skill competency, particularly object-control skills, may contribute to increased levels of children's MVPA throughout the day. Australian New Zealand Clinical Trials Registry No: ACTRN12611001080910.

Barriers to Skilled Birth Attendance: A Survey among Mothers in ...

African Journals Online (AJOL)

More than seventy percent of the participants gave birth attended by a traditional birth attendant, but only 27% had intended to give birth at home. Sixty-four percent had made advance arrangements for the childbirth. Only 22% were informed about expected time of birth during antenatal care. Our findings suggest that the ...

Community-based organizations in the health sector: A scoping review

Directory of Open Access Journals (Sweden)

Wilson Michael G

2012-11-01

Full Text Available Abstract Community-based organizations are important health system stakeholders as they provide numerous, often highly valued programs and services to the members of their community. However, community-based organizations are described using diverse terminology and concepts from across a range of disciplines. To better understand the literature related to community-based organizations in the health sector (i.e., those working in health systems or more broadly to address population or public health issues, we conducted a scoping review by using an iterative process to identify existing literature, conceptually map it, and identify gaps and areas for future inquiry. We searched 18 databases and conducted citation searches using 15 articles to identify relevant literature. All search results were reviewed in duplicate and were included if they addressed the key characteristics of community-based organizations or networks of community-based organizations. We then coded all included articles based on the country focus, type of literature, source of literature, academic discipline, disease sector, terminology used to describe organizations and topics discussed. We identified 186 articles addressing topics related to the key characteristics of community-based organizations and/or networks of community-based organizations. The literature is largely focused on high-income countries and on mental health and addictions, HIV/AIDS or general/unspecified populations. A large number of different terms have been used in the literature to describe community-based organizations and the literature addresses a range of topics about them (mandate, structure, revenue sources and type and skills or skill mix of staff, the involvement of community members in organizations, how organizations contribute to community organizing and development and how they function in networks with each other and with government (e.g., in policy networks. Given the range of terms used to

Embracing a competency-based specialty curriculum for community-based nursing roles.

Science.gov (United States)

Levin, Pamela F; Swider, Susan M; Breakwell, Susan; Cowell, Julia M; Reising, Virginia

2013-01-01

The Quad Council competencies for public health nursing (PHN) provide guidance in developing curricula at both the generalist and specialist level. However, these competencies are based on nursing roles in traditional public health agencies and community/public health is defined more broadly than official agency practice. The question arises as to whether community-based specialties require largely the same knowledge and skill set as PHN. The purpose of the competency cross-mapping project reported here was to (a) assess the intersection of the Quad Council competencies with four community-based specialties and (b) ensure the appropriateness of a Quad Council-based curriculum to prepare graduates across these four specialties (home health, occupational health, environmental health, and school nursing). This article details the multistep cross-mapping process, including validation with practice leaders. Results indicate strong alignment of community-based specialty competencies with Quad Council competencies. Community-based specialty-specific content that did not align well is identified, along with examples of didactic and clinical strategies to address gaps. This work indicates that a Quad Council-based curriculum is appropriate to prepare graduates in community-based specialties when attention to the specialty-specific competencies in the clinical setting is included. This work guides the development of a doctorate of nursing practice curriculum in PHN, encompassing the four additional community-based specialties. © 2013 Wiley Periodicals, Inc.

Losing women along the path to safe motherhood: why is there such a gap between women's use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda.

Science.gov (United States)

Anastasi, Erin; Borchert, Matthias; Campbell, Oona M R; Sondorp, Egbert; Kaducu, Felix; Hill, Olivia; Okeng, Dennis; Odong, Vicki Norah; Lange, Isabelle L

2015-11-04

Thousands of women and newborns still die preventable deaths from pregnancy and childbirth-related complications in poor settings. Delivery with a skilled birth attendant is a vital intervention for saving lives. Yet many women, particularly where maternal mortality ratios are highest, do not have a skilled birth attendant at delivery. In Uganda, only 58 % of women deliver in a health facility, despite approximately 95 % of women attending antenatal care (ANC). This study aimed to (1) identify key factors underlying the gap between high rates of antenatal care attendance and much lower rates of health-facility delivery; (2) examine the association between advice during antenatal care to deliver at a health facility and actual place of delivery; (3) investigate whether antenatal care services in a post-conflict district of Northern Uganda actively link women to skilled birth attendant services; and (4) make recommendations for policy- and program-relevant implementation research to enhance use of skilled birth attendance services. This study was carried out in Gulu District in 2009. Quantitative and qualitative methods used included: structured antenatal care client entry and exit interviews [n = 139]; semi-structured interviews with women in their homes [n = 36], with health workers [n = 10], and with policymakers [n = 10]; and focus group discussions with women [n = 20], men [n = 20], and traditional birth attendants [n = 20]. Seventy-five percent of antenatal care clients currently pregnant reported they received advice during their last pregnancy to deliver in a health facility, and 58 % of these reported having delivered in a health facility. After adjustment for confounding, women who reported they received advice at antenatal care to deliver at a health facility were significantly more likely (aOR = 2.83 [95 % CI: 1.19-6.75], p = 0.02) to report giving birth in a facility. Despite high antenatal care coverage, a number of demand and supply side

Feasibility of a skills-based substance abuse prevention program following traumatic brain injury.

Science.gov (United States)

Vungkhanching, Martha; Heinemann, Allen W; Langley, Mervin J; Ridgely, Mary; Kramer, Karen M

2007-01-01

To demonstrate the feasibility of a skills-based substance abuse prevention counseling program in a community setting for adults who sustained traumatic brain injury. Convenience sample of 117 participants (mean age=35 years) with preinjury history of alcohol or other drug use. Intervention group participants (n=36) from 3 vocational rehabilitation programs; a no-intervention comparison group (n=81) from an outpatient rehabilitation service. 12 individual counseling sessions featuring skills-based intervention. Changes in self-reported alcohol and other drug use, coping skillfulness, affect, and employment status from baseline to 9 months postintervention. Significant differences were noted at baseline for the intervention and comparison groups on ethnicity, time postinjury, marital status, and employment (Pcoping skillfulness (Pskills-based intervention provides a promising approach to promoting abstinence from all substances and increasing readiness for employment for adults with traumatic brain injuries in outpatient settings.

Review of educational interventions to increase traditional birth attendants' neonatal resuscitation self-efficacy.

Science.gov (United States)

Mendhi, Marvesh M; Cartmell, Kathleen B; Newman, Susan D; Premji, Shahirose; Pope, Charlene

2018-05-21

Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality. This review will evaluate the effectiveness of neonatal resuscitation educational interventions in improving traditional birth attendants' knowledge, perceived self-efficacy, and infant mortality outcomes in low-and-middle-income countries. An integrative review was conducted to identify studies pertaining to neonatal resuscitation training of traditional birth attendants and midwives for home-based births in low-and-middle-income countries. Ten studies met inclusion criteria. Most interventions were based on the American Association of Pediatrics Neonatal Resuscitation Program, World Health Organization Safe Motherhood Guidelines and American College of Nurse-Midwives Life Saving Skills protocols. Three studies exclusively for traditional birth attendants reported decreases in neonatal mortality rates ranging from 22% to 65%. These studies utilized pictorial and oral forms of teaching, consistent in addressing the social cognitive theory. Studies employing skill demonstration, role-play, and pictorial charts showed increased pre- to post-knowledge scores and high self-efficacy scores. In two studies, a team approach, where traditional birth attendants were assisted, was reported to decrease neonatal mortality rate from 49-43/1000 births to 10.5-3.7/1000 births. Culturally appropriate methods, such as role-play, demonstration, and pictorial charts, can contribute to increased knowledge and self-efficacy related to neonatal resuscitation. A team approach to training traditional birth attendants, assisted by village health workers during home-based childbirths may reduce neonatal mortality rates. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All

The Community Preceptor Crisis: Recruiting and Retaining Community-Based Faculty to Teach Medical Students-A Shared Perspective From the Alliance for Clinical Education.

Science.gov (United States)

Christner, Jennifer G; Dallaghan, Gary Beck; Briscoe, Gregory; Casey, Petra; Fincher, Ruth Marie E; Manfred, Lynn M; Margo, Katherine I; Muscarella, Peter; Richardson, Joshua E; Safdieh, Joseph; Steiner, Beat D

2016-01-01

Community-based instruction is invaluable to medical students, as it provides "real-world" opportunities for observing and following patients over time while refining history taking, physical examination, differential diagnosis, and patient management skills. Community-based ambulatory settings can be more conducive to practicing these skills than highly specialized, academically based practice sites. The Association of American Medical Colleges and other national medical education organizations have expressed concern about recruitment and retention of preceptors to provide high-quality educational experiences in community-based practice sites. These concerns stem from constraints imposed by documentation in electronic health records; perceptions that student mentoring is burdensome resulting in decreased clinical productivity; and competition between allopathic, osteopathic, and international medical schools for finite resources for medical student experiences. In this Alliance for Clinical Education position statement, we provide a consensus summary of representatives from national medical education organizations in 8 specialties that offer clinical clerkships. We describe the current challenges in providing medical students with adequate community-based instruction and propose potential solutions. Our recommendations are designed to assist clerkship directors and medical school leaders overcome current challenges and ensure high-quality, community-based clinical learning opportunities for all students. They include suggesting ways to orient community clinic sites for students, explaining how students can add value to the preceptor's practice, focusing on educator skills development, recognizing preceptors who excel in their role as educators, and suggesting forms of compensation.

One size fits all partnerships? What explains community partnership leadership skills?

Science.gov (United States)

El Ansari, Walid; Oskrochi, Reza; Phillips, Ceri J

2010-07-01

The authors evaluated W. K. Kellogg-funded Community Partnerships (CPs) between academic, health service, and community partners in South Africa. Stakeholders (N = 668 respondents) completed questionnaires to explore the operational, functional and organisational factors that contribute to members' perceptions of the skills of their CPs' leadership. Ten factors accounted for 53% of leadership skills across five participating CPs and six stakeholder groups. Each CP displayed its unique footprint of factors that accounted for its leadership levels. Similarly, each stakeholder group had its unique signature of factors that were associated with its leadership. Two factors (communication mechanisms and operational understanding) accounted for more than 25% of leadership skills; management capabilities and participation benefits accounted for 4% and 3%; and effectiveness, benefits to difficulties ratio of being a member, engagement in education, flow of information and sense of ownership accounted for 2% to 3% each. Attention to these and other factors is warranted.

A mixed methods investigation into the use of non-technical skills by community and hospital pharmacists.

Science.gov (United States)

Irwin, A; Weidmann, A E

2015-01-01

Non-technical skills refer to the social and cognitive factors that may influence efficient and safe job performance. Non-technical skills are an important element of patient safety in a variety of health care disciplines, including surgery, anesthesia and nursing. However, the use of non-technical skills in pharmacy practice has not yet been fully assessed. To examine attitudes toward, and use of, non-technical skills by pharmacy personnel. A mixed methods approach was used: An attitude survey explored pharmacy personnel attitudes towards non-technical skills and inter-professional collaboration, with community and hospital pharmacy staff (n = 62). Qualitative interviews were then conducted using the critical incident technique, with community pharmacists (n = 11). The survey results demonstrated differences in the opinions of community and hospital pharmacists on three non-technical skill constructs: team structure, mutual support, and situation monitoring, with community pharmacists reporting significantly more positive attitudes about all three constructs. Both groups reported low levels of collaboration with primary care physicians. The interviews identified five non-technical skills as key elements of successful pharmacist performance from the interview transcripts: teamwork; leadership; task management; situation awareness; decision-making. The survey and interviews identified the non-technical skills that are important to pharmacists. This represents the first step towards the development of a behavioral rating system for training purposes that could potentially improve the non-technical skills of pharmacists and enhance patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.

Wellness and illness self-management skills in community corrections.

Science.gov (United States)

Kelly, Patricia J; Ramaswamy, Megha; Chen, Hsiang-Feng; Denny, Donald

2015-02-01

Community corrections provide a readjustment venue for re-entry between incarceration and home for inmates in the US corrections system. Our goal was to determine how self-management skills, an important predictor of re-entry success, varied by demographic and risk factors. In this cross-sectional study, we analyzed responses of 675 clients from 57 community corrections programs run by the regional division of the Federal Bureau of Prisons. A self-administered survey collected data on self-management skills, demographics, and risk factors; significant associations were applied in four regression models: the overall self-management score and three self-management subscales: coping skills, goals, and drug use. Over one-quarter (27.2%/146) of participants had a mental health history. White race, no mental health history and high school education were associated with better overall self-management scores; mental health history and drug use in the past year were associated with lower coping scores; female gender and high school education were associated with better self-management goals; female gender was associated with better self-management drug use scores. Self-management programs may need to be individualized for different groups of clients. Lower scores for those with less education suggest an area for targeted, nurse-led interventions.

Toll free mobile communication: overcoming barriers in maternal and neonatal emergencies in Rural Bangladesh.

Science.gov (United States)

Huq, Nafisa Lira; Azmi, Asrafi Jahan; Quaiyum, M A; Hossain, Shahed

2014-07-12

Toll free mobile telephone intervention to support mothers in pregnancy and delivery period was tested in one sub district of Bangladesh. Qualitative research was conducted to measure the changes of mobile phone use in increasing communication for maternal and neonatal complications. In-depth interviews were conducted among twelve Community Skilled Birth Attendants and fourteen mothers along with their husbands prior to intervention. At intervention end, six Community Skilled Birth Attendants were purposively selected for in-depth interview. Semi structured interviews were conducted among all 27 Community Skilled Birth Attendants engaged in the intervention. One Focus Group Discussion was conducted with 10 recently delivered mothers. Thematic analysis and triangulation of different responses were conducted. Prior to intervention, Community Skilled Birth Attendants reported that mobile communication was not a norm. It was also revealed that poor mothers had poor accessibility to mobile services. Mothers, who communicated through mobile phone with providers noted irritability from Community Skilled Birth Attendants and sometimes found phones switched off. At the end of the project, 85% of mothers who had attended orientation sessions of the intervention communicated with Community Skilled Birth Attendants through mobile phones during maternal health complications. Once a complication is reported or anticipated over phone, Community Skilled Birth Attendants either made a prompt visit to mothers or advised for direct referral. More than 80% Community Skilled Birth Attendants communicated with Solution Linked Group for guidance on maternal health management. Prior to intervention, Solution Linked Group was not used to receive phone call from Community Skilled Birth Attendants. Community Skilled Birth Attendants were valued by the mothers. Mothers viewed that Community Skilled Birth Attendants are becoming confident in managing complication due to communication with

Preventing Repeat Teen Births PSA (:60)

Centers for Disease Control (CDC) Podcasts

This 60 second public service announcement is based on the April 2013 CDC Vital Signs report, which discusses repeat teen births and ways teens, parents and guardians, health care providers, and communities can help prevent them.

Identifying Effective Methods of Instruction for Adult Emergent Readers through Community-Based Research

Science.gov (United States)

Blackmer, Rachel; Hayes-Harb, Rachel

2016-01-01

We present a community-based research project aimed at identifying effective methods and materials for teaching English literacy skills to adult English as a second language emergent readers. We conducted a quasi-experimental study whereby we evaluated the efficacy of two approaches, one based on current practices at the English Skills Learning…

Promoting Community Health and Eliminating Health Disparities Through Community-Based Participatory Research.

Science.gov (United States)

Xia, Ruiping; Stone, John R; Hoffman, Julie E; Klappa, Susan G

2016-03-01

In physical therapy, there is increasing focus on the need at the community level to promote health, eliminate disparities in health status, and ameliorate risk factors among underserved minorities. Community-based participatory research (CBPR) is the most promising paradigm for pursuing these goals. Community-based participatory research stresses equitable partnering of the community and investigators in light of local social, structural, and cultural elements. Throughout the research process, the CBPR model emphasizes coalition and team building that joins partners with diverse skills/expertise, knowledge, and sensitivities. This article presents core concepts and principles of CBPR and the rationale for its application in the management of health issues at the community level. Community-based participatory research is now commonly used to address public health issues. A literature review identified limited reports of its use in physical therapy research and services. A published study is used to illustrate features of CBPR for physical therapy. The purpose of this article is to promote an understanding of how physical therapists could use CBPR as a promising way to advance the profession's goals of community health and elimination of health care disparities, and social responsibility. Funding opportunities for the support of CBPR are noted. © 2016 American Physical Therapy Association.

Assessing Leadership and Problem-Solving Skills and Their Impacts in the Community.

Science.gov (United States)

Rohs, F. Richard; Langone, Christine A.

1993-01-01

A pretest-posttest control group design was used to assess the leadership and problem-solving skills of 281 participants and 110 controls in a statewide community leadership development program. Quantitative and qualitative data demonstrate that the program has been a catalyst to influence leadership and problem-solving skills for community…

A qualitative study of advanced nurse practitioners' use of physical assessment skills in the community: shifting skills across professional boundaries.

Science.gov (United States)

Raleigh, Mary; Allan, Helen

2017-07-01

To explore multiple perspectives on the use of physical assessment skills by advanced nurse practitioners in the UK. Physical assessment skills practices are embedded in advanced nursing practice roles in the UK. There is little evidence on how these skills are used by advanced nurse practitioners in the community. Case study. A qualitative interpretative single-embedded case study of 22 participants from South of England. A framework method analysed interview data collected by the researcher between March-August 2013. Participants included nurses, doctors, nurse educators and managers. Physical assessment skills education at universities is part of a policy shift to develop a flexible workforce in the UK. Shared physical assessment practices are less to do with role substitution and more about preparing practitioners with skills that are fit for purpose. Competence, capability and performance with physical assessment skills are an expectation of advanced nursing practice. These skills are used successfully by community advanced nurse practitioners to deliver a wide range of services in response to changing patient need. The introduction of physical assessment skills education to undergraduate professional preparation would create a firm foundation to develop these skills in postgraduate education. Physical assessment education prepares nurses with the clinical competencies to carry out healthcare reforms in the UK. Shared sets of clinical assessment competencies between disciplines have better outcomes for patients. Levels of assessment competence can depend on the professional attributes of individual practitioners. Unsupportive learning cultures can hinder professional development of advanced nursing practice. © 2016 John Wiley & Sons Ltd.

Accelerated Training of Skilled Birth Attendants in a Marginalized Population on the Thai-Myanmar Border: A Multiple Methods Program Evaluation.

Directory of Open Access Journals (Sweden)

Adrienne Lynne White

Full Text Available To evaluate a skilled birth attendant (SBA training program in a neglected population on the Thai-Myanmar border, we used multiple methods to show that refugee and migrant health workers can be given effective training in their own environment to become SBAs and teachers of SBAs. The loss of SBAs through resettlement to third countries necessitated urgent training of available workers to meet local needs.All results were obtained from student records of theory grades and clinical log books. Qualitative evaluation of both the SBA and teacher programs was obtained using semi-structured interviews with supervisors and teachers. We also reviewed perinatal indicators over an eight-year period, starting prior to the first training program until after the graduation of the fourth cohort of SBAs.Four SBA training programs scheduled between 2009 and 2015 resulted in 79/88 (90% of students successfully completing a training program of 250 theory hours and 625 supervised clinical hours. All 79 students were able to: achieve pass grades on theory examination (median 80%, range [70-89]; obtain the required clinical experience within twelve months; achieve clinical competence to provide safe care during childbirth. In 2010-2011, five experienced SBAs completed a train-the-trainer (TOT program and went on to facilitate further training programs. Perinatal indicators within Shoklo Malaria Research Unit (SMRU, such as place of birth, maternal and newborn outcomes, showed no significant differences before and after introduction of training or following graduate deployment in the local maternity units. Confidence, competence and teamwork emerged from qualitative evaluation by senior SBAs working with and supervising students in the clinics.We demonstrate that in resource-limited settings or in marginalized populations, it is possible to accelerate training of skilled birth attendants to provide safe maternity care. Education needs to be tailored to local needs to

Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion.

Science.gov (United States)

Mumtaz, Zubia; O'Brien, Beverley; Bhatti, Afshan; Jhangri, Gian S

2012-09-19

Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW). A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW's in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial) that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women's marginalization from health care systems, including community midwifery care. One key outcome will be an increased sensitization

Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion

Directory of Open Access Journals (Sweden)

Mumtaz Zubia

2012-09-01

Full Text Available Abstract Background Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW. A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Methods/Design Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW’s in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. Discussion The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems, including

Lessons learned from a community-academic initiative: the development of a core competency-based training for community-academic initiative community health workers.

Science.gov (United States)

Ruiz, Yumary; Matos, Sergio; Kapadia, Smiti; Islam, Nadia; Cusack, Arthur; Kwong, Sylvia; Trinh-Shevrin, Chau

2012-12-01

Despite the importance of community health workers (CHWs) in strategies to reduce health disparities and the call to enhance their roles in research, little information exists on how to prepare CHWs involved in community-academic initiatives (CAIs). Therefore, the New York University Prevention Research Center piloted a CAI-CHW training program. We applied a core competency framework to an existing CHW curriculum and bolstered the curriculum to include research-specific sessions. We employed diverse training methods, guided by adult learning principles and popular education philosophy. Evaluation instruments assessed changes related to confidence, intention to use learned skills, usefulness of sessions, and satisfaction with the training. Results demonstrated that a core competency-based training can successfully affect CHWs' perceived confidence and intentions to apply learned content, and can provide a larger social justice context of their role and work. This program demonstrates that a core competency-based framework coupled with CAI-research-specific skill sessions (1) provides skills that CAI-CHWs intend to use, (2) builds confidence, and (3) provides participants with a more contextualized view of client needs and CHW roles.

Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States.

Science.gov (United States)

Bovbjerg, Marit L; Cheyney, Melissa; Brown, Jennifer; Cox, Kim J; Leeman, Lawrence

2017-09-01

There is little agreement on who is a good candidate for community (home or birth center) birth in the United States. Data on n=47 394 midwife-attended, planned community births come from the Midwives Alliance of North America Statistics Project. Logistic regression quantified the independent contribution of 10 risk factors to maternal and neonatal outcomes. Risk factors included: primiparity, advanced maternal age, obesity, gestational diabetes, preeclampsia, postterm pregnancy, twins, breech presentation, history of cesarean and vaginal birth, and history of cesarean without history of vaginal birth. Models controlled additionally for Medicaid, race/ethnicity, and education. The independent contributions of maternal age and obesity were quite modest, with adjusted odds ratios (AOR) less than 2.0 for all outcomes: hospital transfer, cesarean, perineal trauma, postpartum hemorrhage, low/very-low Apgar, maternal or neonatal hospitalization, NICU admission, and fetal/neonatal death. Breech was strongly associated with morbidity and fetal/neonatal mortality (AOR 8.2, 95% CI, 3.7-18.4). Women with a history of both cesarean and vaginal birth fared better than primiparas across all outcomes; however, women with a history of cesarean but no prior vaginal births had poor outcomes, most notably fetal/neonatal demise (AOR 10.4, 95% CI, 4.8-22.6). Cesarean births were most common in the breech (44.7%), preeclampsia (30.6%), history of cesarean without vaginal birth (22.1%), and primipara (11.0%) groups. The outcomes of labor after cesarean in women with previous vaginal deliveries indicates that guidelines uniformly prohibiting labor after cesarean should be reconsidered for this subgroup. Breech presentation has the highest rate of adverse outcomes supporting management of vaginal breech labor in a hospital setting. © 2017 Wiley Periodicals, Inc.

Lessons from the Labor Organizing Community and Health Project: Meeting the Challenges of Student Engagement in Community Based Participatory Research

Science.gov (United States)

Allison, Juliann Emmons; Khan, Tabassum; Reese, Ellen; Dobias, Becca Spence; Struna, Jason

2015-01-01

Community Based Participatory Research (CBPR) provides opportunities for scholars and students to respond directly to community needs; students also practice critical thinking, problem-solving, and conflict-resolution skills necessary for professional life and engaged citizenship. The challenges of involving undergraduate students in CBPR include…

A qualitative study of advanced nurse practitioners’ use of physical assessment skills in the community: shifting skills across professional boundaries

OpenAIRE

Raleigh, Mary; Allan, Helen T.

2017-01-01

Aim\\ud To explore multiple perspectives on the use of physical assessment skills by Advanced Nurse Practitioners in the UK\\ud Background \\ud Physical assessment skills practices are embedded in advanced nursing practice roles in the UK. There is little evidence on how these skills are used by Advanced Nurse Practitioners' on the community.\\ud Design \\ud Case study\\ud Methodology and methods. \\ud A qualitative interpretative single-embedded case study of 22 participants from South of England. ...

Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study

NARCIS (Netherlands)

Hermus, M.A.A.; Hitzert, M.; Boesveld, I.I.; Akker-van Marle, E.M. van den; Dommelen, P. van; Franx, A.; Graaf, J.P. de; Lith, J.M.M. van; Steegers, E.E.; Wiegers, T.A.; Pal-de Bruin, K.K. van der

2017-01-01

Objectives To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. Design Prospective cohort study. Setting Low-risk pregnant women

Participant experiences of mindfulness-based childbirth education: a qualitative study

Directory of Open Access Journals (Sweden)

Fisher Colleen

2012-11-01

Full Text Available Abstract Background Childbirth is an important transitional life event, but one in which many women are dissatisfied stemming in part from a sense that labour is something that happens to them rather than with them. Promoting maternal satisfaction with childbirth means equipping women with communication and decision making skills that will enhance their ability to feel involved in their labour. Additionally, traditional antenatal education does not necessarily prepare expectant mothers and their birth support partner adequately for birth. Mindfulness-based interventions appear to hold promise in addressing these issues. Mindfulness-based Child Birth Education (MBCE was a pilot intervention combining skills-based antenatal education and Mindfulness Based Stress Reduction. Participant experiences of MBCE, both of expectant mothers and their birth support partners are the focus of this article. Methods A generic qualitative approach was utilised for this study. Pregnant women between 18 and 28 weeks gestation, over 18 years of age, nulliparous with singleton pregnancies and not taking medication for a diagnosed mental illness or taking illicit drugs were eligible to undertake the MBCE program which was run in a metropolitan city in Australia. Focus groups with 12 mothers and seven birth support partners were undertaken approximately four months after the completion of MBCE. Audio recordings of the groups were transcribed verbatim and analysed thematically using the method of constant comparison by all four authors independently and consensus on analysis and interpretation arrived at through team meetings. Results A sense of both ‘empowerment’ and ‘community’ were the essences of the experiences of MBCE both for mothers and their birth support partner and permeated the themes of ‘awakening my existing potential’ and ‘being in a community of like-minded parents’. Participants suggested that mindfulness techniques learned during MBCE

Community-based distribution of misoprostol to prevent postpartum haemorrhage at home births: results from operations research in rural Ghana.

Science.gov (United States)

Geller, S; Carnahan, L; Akosah, E; Asare, G; Agyemang, R; Dickson, R; Kapungu, C; Owusu-Ansah, L; Robinson, N; Mensah-Homiah, J

2014-02-01

To report on a rigorous distribution and monitoring plan to track misoprostol for community-based distribution to reduce postpartum haemorrhage (PPH) in rural Ghana. Operations research. Rural Ghana. Women in third trimester of pregnancy presenting to primary health centres (PHCs) for antenatal care (ANC). Ghana Health Service (GHS), Millennium Village Projects, and the University of Illinois at Chicago conducted an operations research study designed to assess the safety, feasibility, and acceptability of community-based distribution of misoprostol to prevent PPH at home deliveries in rural Ghana. One thousand doses (3000 tablets, 200 μg each) were obtained from the Family Health Division of GHS. Three 200-μg tablets of misoprostol (600 μg) in foil packets were packaged together in secured transparent plastic packets labelled with pictorial messages and distributed to midwives at seven PHCs for distribution to pregnant women. Correct use of misoprostol in home deliveries and retrieval of unused misoprostol doses, PPH rates and maternal mortality. Of the 999 doses distributed to midwives, 982 (98.3%) were successfully tracked, with a 1.7% lost to follow-up rate. Midwives distributed 654 doses to women at third-trimester ANC visits. Of women who had misoprostol to use at home, 81% had an institutional delivery and were able to return the misoprostol safely to the midwife. Of the women that used misoprostol, 99% used the misoprostol correctly. This study clearly demonstrates that misoprostol distributed antenatally to pregnant women can be used accurately and reliably by rural Ghanaian women, and should be considered for policy implementation across Ghana and other countries with high home birth rates and maternal mortality ratios. © 2013 Royal College of Obstetricians and Gynaecologists.

Defining and describing birth centres in the Netherlands - a component study of the Dutch Birth Centre Study.

Science.gov (United States)

Hermus, M A A; Boesveld, I C; Hitzert, M; Franx, A; de Graaf, J P; Steegers, E A P; Wiegers, T A; van der Pal-de Bruin, K M

2017-07-03

During the last decade, a rapid increase of birth locations for low-risk births, other than conventional obstetric units, has been seen in the Netherlands. Internationally some of such locations are called birth centres. The varying international definitions for birth centres are not directly applicable for use within the Dutch obstetric system. A standard definition for a birth centre in the Netherlands is lacking. This study aimed to develop a definition of birth centres for use in the Netherlands, to identify these centres and to describe their characteristics. International definitions of birth centres were analysed to find common descriptions. In July 2013 the Dutch Birth Centre Questionnaire was sent to 46 selected Dutch birth locations that might qualify as birth centre. Questions included: location, reason for establishment, women served, philosophies, facilities that support physiological birth, hotel-facilities, management, environment and transfer procedures in case of referral. Birth centres were visited to confirm the findings from the Dutch Birth Centre Questionnaire and to measure distance and time in case of referral to obstetric care. From all 46 birth locations the questionnaires were received. Based on this information a Dutch definition of a birth centre was constructed. This definition reads: "Birth centres are midwifery-managed locations that offer care to low risk women during labour and birth. They have a homelike environment and provide facilities to support physiological birth. Community midwives take primary professional responsibility for care. In case of referral the obstetric caregiver takes over the professional responsibility of care." Of the 46 selected birth locations 23 fulfilled this definition. Three types of birth centres were distinguished based on their location in relation to the nearest obstetric unit: freestanding (n = 3), alongside (n = 14) and on-site (n = 6). Transfer in case of referral was necessary for all

Placentophagy among women planning community births in the United States: Frequency, rationale, and associated neonatal outcomes.

Science.gov (United States)

Benyshek, Daniel C; Cheyney, Melissa; Brown, Jennifer; Bovbjerg, Marit L

2018-05-02

Limited systematic research on maternal placentophagy is available to maternity care providers whose clients/patients may be considering this increasingly popular practice. Our purpose was to characterize the practice of placentophagy and its attendant neonatal outcomes among a large sample of women in the United States. We used a medical records-based data set (n = 23 242) containing pregnancy, birth, and postpartum information for women who planned community births. We used logistic regression to determine demographic and clinical predictors of placentophagy. Finally, we compared neonatal outcomes (hospitalization, neonatal intensive unit admission, or neonatal death in the first 6 weeks) between placenta consumers and nonconsumers, and participants who consumed placenta raw vs cooked. Nearly one-third (31.2%) of women consumed their placenta. Consumers were more likely to have reported pregravid anxiety or depression compared with nonconsumers. Most (85.7%) placentophagic mothers consumed their placentas in encapsulated form, and nearly half (49.1%) consumed capsules containing dehydrated, uncooked placenta. Placentophagy was not associated with any adverse neonatal outcomes. Women with home births were more likely to engage in placentophagy than women with birth center births. The most common reason given (58.6%) for engaging in placentophagy was to prevent postpartum depression. The majority of women consumed their placentas in uncooked/encapsulated form and hoping to avoid postpartum depression, although no evidence currently exists to support this strategy. Preparation technique (cooked vs uncooked) did not influence adverse neonatal outcomes. Maternity care providers should discuss the range of options available to prevent/treat postpartum depression, in addition to current evidence with respect to the safety of placentophagy. © 2018 Wiley Periodicals, Inc.

The Relationship between Birth Order and Academic Achievement.

Science.gov (United States)

Cherry, Crystal M.

This paper reviews the literature on the relationship between birth order and several variables, especially academic achievement. One study found a relationship between leadership skills and birth order for males. Several studies found no relationship between birth order and academic achievement; grade point average; self-esteem; locus of control…

Community Factors Influencing Birth Spacing among Married ...

African Journals Online (AJOL)

AJRH Managing Editor

level factors on birth spacing behaviour in Uganda and Zimbabwe, to ... environments as potential influences on birth spacing ..... health: multivariable cross-country analysis, MACRO ... Equity monitoring for social marketing: Use of wealth.

Condition of karangkepatihan village community balong district ponorogo regency in supporting development of community based tourism

Science.gov (United States)

Sutedjo, A.; Prasetyo, K.; Sudaryono, L.

2018-01-01

In Karangkepatihan village, it can be found some attractions that have the potential to develop. Some attractions have been developed by involving the community in its management, but its development has not been as expected. The purpose of this research is to know the attitude of the community and the level of human resources of the community of Karangkepatihan village in supporting the development of community-based tourism and the right strategy for its development. Subjects in this study were the head of the family and the physical condition of tourist objects, with a sample of 100 family heads taken randomly. Research data which are knowledge, understanding, participation, support to the development of tourism and level of education and skill obtained by interview while observation is done to get potential data of tourism object. The data obtained are analyzed by using scoring technique and SWOT analysis. The results show that community attitudes are positive in supporting community-based tourism development, but have not been shown to participate in developing tourism in Karangkepatihan village. The level of human resources in Karangkepatihan village to support the development of tourism is low so that the development of tourism is slow. An appropriate strategy for developing tourism development in Karangkepatihan village is to grow and build. Improving the skills of the community to fill the job opportunities in the field of tourism, increase the participation or involvement of the community in tourism activities, increasing the accessibility of tourism objects, increasing the facilities and infrastructure of tourism needs to be done.

National Migrant Education Program: Early Childhood Development Skills--Birth Through 5 Years (Desarrollo de Destrezas en la Temprana Infancia--Desde el Nacimiento Hasta los Cinco Anos de Edad).

Science.gov (United States)

1979

Compiled to ensure cooperation between states and to provide continuity of reporting on developmental skills for the migrant child from birth through five years of age, this booklet lists the psychomotor, cognitive, and affective skills which are reported through the Migrant Student Record Transfer System (MSRTS). Published in both English and…

IMPLEMENTATION BIRTH PLANNING AND COMPLICATIONS PREVENTIONS PROGRAM (P4K ON COASTAL COMMUNITIES IN MAMUJU

Directory of Open Access Journals (Sweden)

Ashriady Ashriady

2017-01-01

Full Text Available The results of the 97 countries, there is a significant correlation between aid delivery with maternal mortality (Depkes, 2011. Proportion of birth in Indonesia showed 76.1% in Healthcare Facilities and 23.7% in home and another (Kemenkes RI, 2014. In the coastal community primary choices deliveries take place at home, assisted by shamans because mothers feel safe from evil spirits, and convenient for the family attended (Yunarti, 2013. Scope of delivery assistance by health workers in 2006 - 2011 in West Sulawesi has not reached the target of minimum service standards in 2015 by 90%, obstetric complications handled in 2011 in Mamuju 35.1%. The aim of research to analyze the implementation of Birth Planning and Complications Preventions Program (P4K based on the knowledge and attitude of Mother on Coastal Communities in Mamuju. This type of research is survey with cross sectional study design. In the study period in August-October 2016. The population is all Mother toddler who visited IHC 330, 149 of the samples obtained by using the formula, taken by accidental sampling method. The results showed 68 (81.9% of respondents have sufficient knowledge of the implementation of the less well P4K, 113 (79.6% positive attitude to the implementation mother P4K less good, there is no statistical relationship between knowledge and attitude of mothers with implementation P4K. Midwives need intensive assistance in filling and installation sticker P4K at home mom.

Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population-based study.

Science.gov (United States)

Engjom, Hilde M; Morken, Nils-Halvdan; Høydahl, Even; Norheim, Ole F; Klungsøyr, Kari

2017-08-01

Births in midwife-led institutions may reduce the frequency of medical interventions and provide cost-effective care, while larger institutions offer medically and technically advanced obstetric care. Unplanned births outside an institution and intrapartum stillbirths have frequently been excluded in previous studies on adverse outcomes by place of birth. The objective of the study was to assess peripartum mortality by place of birth and travel time to obstetric institutions, with the hypothesis that centralization reduces institution availability but improves mortality. This was a national population-based retrospective cohort study of all births in Norway from 1999 to 2009 (n = 648,555) using data from the Medical Birth Registry of Norway and Statistics Norway and including births from 22 gestational weeks or birthweight ≥500 g. Main exposures were travel time to the nearest obstetric institution and place of birth. The main clinical outcome was peripartum mortality, defined as death during birth or within 24 hours. Intrauterine fetal deaths prior to start of labor were excluded from the primary outcome. A total of 1586 peripartum deaths were identified (2.5 per 1000 births). Unplanned birth outside an institution had a 3 times higher mortality (8.4 per 1000) than institutional births (2.4 per 1000), relative risk, 3.5 (95% confidence interval, 2.5-4.9) and contributed 2% (95% confidence interval, 1.2-3.0%) of the peripartum mortality at the population level. The risk of unplanned birth outside an institution increased from 0.5% to 3.3% and 4.5% with travel time 2 hours, respectively. In obstetric institutions the mortality rate at term ranged from 0.7 per 1000 to 0.9 per 1000. Comparable mortality rates in different obstetric institutions indicated well-functioning routines for referral. Unplanned birth outside an institution was associated with increased peripartum mortality and with long travel time to obstetric institutions. Structural determinants have

Simulation based training in a publicly funded home birth programme in Australia: A qualitative study.

Science.gov (United States)

Kumar, Arunaz; Nestel, Debra; Stoyles, Sally; East, Christine; Wallace, Euan M; White, Colleen

2016-02-01

Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. However there is a small risk of emergencies requiring immediate, skilled management to optimise maternal and neonatal outcomes. We developed and implemented a simulation workshop designed to run in a home based setting to assist with emergency training for midwives and paramedical staff. The workshop was evaluated by assessing participants' satisfaction and response to key learning issues. Midwifery and emergency paramedical staff attending home births participated in a simulation workshop where they were required to manage birth emergencies in real time with limited availability of resources to suit the setting. They completed a pre-test and post-test evaluation form exploring the content and utility of the workshops. Content analysis was performed on qualitative data regarding the most important learning from the simulation activity. A total of 73 participants attended the workshop (midwifery=46, and paramedical=27). There were 110 comments, made by 49 participants. The most frequently identified key learning elements were related to communication (among midwives, paramedical and hospital staff and with the woman's partner), followed by recognising the role of other health care professionals, developing an understanding of the process and the importance of planning ahead. Home birth simulation workshop was found to be a useful tool by staff that provide care to women who are having a planned home birth. Developing clear communication and teamwork were found to be the key learning principles guiding their practice. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Effect of mHealth in improving antenatal care utilization and skilled birth attendance in low- and middle-income countries: a systematic review protocol.

Science.gov (United States)

Abraha, Yosef G; Gebrie, Serebe A; Garoma, Desalegn A; Deribe, Fasil M; Tefera, Mamuye H; Morankar, Sudhakar

2017-07-01

The objective of this review is to identify and synthesize the best available evidence on the effect of mobile health (mHealth) interventions in antenatal care utilization and skilled birth attendance in low- and middle-income countries.More specifically, the review questions are as follows.

Ethnic Differences for Public Health Knowledge, Health Advocacy Skills, and Health Information Seeking Among High School Students: Community Agents of Change.

Science.gov (United States)

Kratzke, Cynthia; Rao, Satya; Marquez, Ruben

2018-03-06

Although adult health advocacy programs have been examined in communities, little is known about integrated adolescent health advocacy programs in high schools. The purpose of this study was to examine the health advocacy program impact and ethnic differences among high school students. Using a cross-sectional study, high school students participating in the school-based program completed evaluation surveys. The program domains included upstream causes of health, community assets, and public health advocacy. Bivariate analyses were conducted to examine ethnic differences for public health knowledge, health advocacy skills, and health information seeking behaviors. Using thematic analysis, open-ended survey item responses were coded to identify themes for students' perceptions of community health. Non-Hispanic (n = 72) and Hispanic high school students (n = 182) in ten classes reported owning smartphones (95%) and laptops (76%). Most students (72%) reported seeking online health information. Non-Hispanic students reported significantly higher health advocacy skills for speaking with the class about health issues, identifying community services, or creating health awareness at school than Hispanic students. Non-Hispanic students were more likely to seek health information from fathers and television than Hispanic students. Hispanic students were more likely to seek health information from hospital or clinic staff than non-Hispanic students. Emergent themes included health advocacy skills, community awareness, and individual and community health changes. High schools benefit from integrating health advocacy programs into the core curriculum. Adolescents gain important skills to improve their individual health and engage in changing community health.

Training Zambian traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival Project (LUNESP).

Science.gov (United States)

Gill, Christopher J; Guerina, Nicholas G; Mulenga, Charity; Knapp, Anna B; Mazala, Grace; Hamer, Davidson H

2012-07-01

To provide relevant details on how interventions in the Lufwanyama Neonatal Survival Project (LUNESP) were developed and how Zambian traditional birth attendants (TBAs) were trained to perform them. The study tested 2 interventions: a simplified version of the American Academy of Pediatrics' neonatal resuscitation protocol (NRP); and antibiotics with facilitated referral (AFR). Key elements that enabled the positive study result were: focusing on common and correctible causes of mortality; selecting a study population with high unmet public health need; early community mobilization to build awareness and support; emphasizing simplicity in the intervention technology and algorithms; using a traditional training approach appropriate to students with low literacy rates; requiring TBAs to demonstrate their competence before completing each workshop; and minimizing attrition of skills by retraining and reassessing the TBAs regularly throughout the study. An effective NRP training model was created that is suitable for community-based neonatal interventions, in research or programmatic settings, and by practitioners with limited obstetric skills and low rates of literacy. Clinicaltrials.gov NCT00518856. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Birth attendance and magnitude of obstetric complications in Western Kenya: a retrospective case-control study.

Science.gov (United States)

Liambila, Wilson N; Kuria, Shiphrah N

2014-09-08

Skilled birth attendance is critical in the provision of child birth related services. Yet, literature is scanty on the outcomes of child birth related complications in situations where majority of women deliver under the care of non-skilled birth attendants compared to those who are assisted by skilled providers. The study sought to assess the nature of childbirth related complications among the skilled and the non-skilled birth attendants in Western Kenya. A case-control study was conducted among women aged 15-49 years at the household. Controls were individually matched to cases on the basis of age and socio-economic status. A total of 294 cases and 291 controls were interviewed. Data were collected on various demographic and socio-economic characteristics and women's perception on the quality of care. All independent variables were analysed initially in bivariate models and those that were significantly associated with obstetric complications were included in multiple logistic regression model in order to control for confounding factors. Odds ratios (ORs), with 95% confidence intervals, were computed to show the association between the occurrence, magnitude and the extent to which child birth related complications were managed. Demographic and socio-economic characteristics of the cases and controls were similar. About 52% of the deliveries were assisted by skilled birth attendants while non-skilled providers attended to 48% of them. The odds of the occurrence of obstetric complications were greater among the women who were attended to by skilled providers in health facilities: adjusted odds ratio (AOR): 1.32 (CI 0.95, 1.84) than among those who were assisted by unskilled birth attendants, AOR 0.76 (CI 0.55, 1.06). Undignified care, high delivery and transport costs and fear of hospital procedures such as HIV tests and mishandling of the placenta were cited as some of the barriers to facility deliveries. Skilled birth attendants in facilities were associated

Integrated Basic Education and Skills Training (I-BEST). Washington's Community and Technical Colleges

Science.gov (United States)

Washington State Board for Community and Technical Colleges, 2014

2014-01-01

Washington's Integrated Basic Education and Skills Training Program (I-BEST) quickly teaches students literacy, work, and college-readiness skills so they can move through school and into living wage jobs faster. Pioneered by Washington's community and technical colleges, I-BEST uses a team-teaching approach to combine college-readiness classes…

Development of Leadership Skills in Community College Department Chairs

Science.gov (United States)

Sirkis, Jocelyn Eager

2011-01-01

The role of a community college department chairperson is not well defined and the job is often perceived as more of a burden than an honor. Faculty come to the position frequently by "default" and without a ready set of management and leadership skills. The matter is of concern since chairs influence academic department strategy, culture, and…

Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan.

Science.gov (United States)

Hameed, Waqas; Avan, Bilal Iqbal

2018-01-01

.75). Sub-group analyses for home-based births identified the same significant associations with mistreatment, with ethnicity included. In facility-based births, there was a significant relationship between women's employment and empowerment status and mistreatment. Women with prior education on birth preparedness were less likely to experience mistreatment compared to those who had received no previous birth preparedness education. In order to promote care that is woman-centred and provided in a respectful and culturally appropriate manner, service providers should be cognisant of the current situation and ensure provision of quality antenatal care. At the community level, women should seek antenatal care for improved birth preparedness, while at the interpersonal level strategies should be devised to leverage women's ability to participate in key household decisions.

Making Pregnancy Safer-Birth Preparedness and Complication Readiness Study Among Antenatal Women Attendees of A Primary Health Center, Delhi

Directory of Open Access Journals (Sweden)

Anita Shankar Acharya

2015-01-01

Full Text Available Background: Every pregnancy is a joyful moment for all mothers who dream of a safe pregnancy and a healthy baby. However, every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to herself or to her infant. Birth preparedness and complication readiness (BPACR is a strategy that encourages pregnant women, their families, and communities to effectively plan for births and deal with emergencies, if they occur. It is a key component of globally accepted safe motherhood programs. Objectives: The objective of our study was to assess the status of BPACR among pregnant women and to study the socio-demographic factors affecting BPACR. Materials and Methods: We conducted a facility-based cross-sectional study among 417 antenatal attendees at a primary health center, Palam, New Delhi from January to April 2012. Knowledge about danger signs, planning for transport, place, and delivery by skilled birth attendant, financial management, and outcome were assessed. BPACR index was calculated. Results: Our study revealed that the BPACR index was very low (41% although the preparedness level was high. Majority (81.1% had identified a skilled attendant at birth for delivery. Nearly half of the women (48.9% had saved money for delivery and 44.1% women had also identified a mode of transportation for the delivery. However, only 179 (42.9% women were aware about early registration of pregnancy. Only one-third (33.1% of women knew about four or more antenatal visits during pregnancy. Overall, only 27.8% women knew about any one danger sign of pregnancy. Conclusion: The level of awareness regarding BPACR was very low (41%. Efforts should be targeted to increase the awareness regarding components of BPACR among pregnant women and their families at the Primary Health Center (PHC as well as at the community level. This will indeed go a long way in reducing morbidity as well as mortality in pregnant women, thus enabling

Community-Based Choirs of Sorsogon, Philippines: An Outcomes- Based Education Output of Bachelor of Secondary Education Major in Music, Arts, PE and Health

Directory of Open Access Journals (Sweden)

Alfonso Legaspi Garcia Jr.

2017-02-01

Full Text Available As a response to the call for an Outcomes- Based Education instructional design and initiatives by the Commission on Higher Education in the Teacher Education Curriculum, the Bachelor in Secondary Education major in Music, Arts Physical Education and Health (BSED-MAPEH of one state college in the Philippines, organized and trained community-based choirs in their localities in the province of Sorsogon, Philippines as an Outcomes-Based Education project/immersion. This observation-participatory qualitative research described and analyzed the four community- based choir organized by the Bachelor in Secondary Education Major in MAPEH fourth year students from Teacher Education department for the School Year 2015-2016. There were 15 key informants. Data are gathered through questionnaire, structured and unstructured interview, direct observation and participation and it was analyzed using triangulation, cross-matrix analysis, documentary (pictures and videos. Results show that the four-organized community-based choir groups have similarities and differences in terms of their vision, organizational structures, membership, song repertoire, practices, rehearsals and concert theme/presentation. It is also revealed that the students- organizers faced and hurdled challenges along; training of choir, leadership and management skills, Event management, resources management and communication skills (oral and written. And the activity as an Outcomes-Based Education practicum/immersion gave remarkable impacts on their personality development, choral music skills, communication skills, leadership, organization and management skills and financial or resource management.

Helping Mothers Survive Bleeding After Birth: retention of knowledge, skills, and confidence nine months after obstetric simulation-based training

NARCIS (Netherlands)

Nelissen, E.J.T.; Ersdal, H.; Mduma, E.; Evjen-Olsen, B.; Broerse, J.E.W.; van Roosmalen, J.; Stekelenburg, J.

2015-01-01

Background: It is important to know the decay of knowledge, skills, and confidence over time to provide evidence-based guidance on timing of follow-up training. Studies addressing retention of simulation-based education reveal mixed results. The aim of this study was to measure the level of

Helping Mothers Survive Bleeding After Birth : retention of knowledge, skills, and confidence nine months after obstetric simulation-based training

NARCIS (Netherlands)

Nelissen, Ellen; Ersdal, Hege; Mduma, Estomih; Evjen-Olsen, Bjorg; Broerse, Jacqueline; van Roosmalen, Jos; Stekelenburg, Jelle

2015-01-01

Background: It is important to know the decay of knowledge, skills, and confidence over time to provide evidence-based guidance on timing of follow-up training. Studies addressing retention of simulation-based education reveal mixed results. The aim of this study was to measure the level of

Birth outcomes of planned home births in Missouri: a population-based study.

Science.gov (United States)

Chang, Jen Jen; Macones, George A

2011-08-01

We evaluated the birth outcomes of planned home births. We conducted a retrospective cohort study using Missouri vital records from 1989 to 2005 to compare the risk of newborn seizure and intrapartum fetal death in planned home births attended by physicians/certified nurse midwives (CNMs) or non-CNMs with hospitals/birthing center births. The study sample included singleton pregnancies between 36 and 44 weeks of gestation without major congenital anomalies or breech presentation ( N = 859,873). The adjusted odds ratio (aOR) of newborn seizures in planned home births attended by non-CNMs was 5.11 (95% confidence interval [CI]: 2.52, 10.37) compared with deliveries by physicians/CNMs in hospitals/birthing centers. For intrapartum fetal death, aORs were 11.24 (95% CI: 1.43, 88.29), and 20.33 (95% CI: 4.98, 83.07) in planned home births attended by non-CNMs and by physicians/CNMs, respectively, compared with births in hospitals/birthing centers. Planned home births are associated with increased likelihood of adverse birth outcomes. © Thieme Medical Publishers.

FREE MOVEMENT OF SKILLED LABOR WITHIN THE ASEAN ECONOMIC COMMUNITY

Directory of Open Access Journals (Sweden)

Mita Adhisti

2017-06-01

Full Text Available This paper will discuss how the free movement of skilled labor policy under the ASEAN Economic Community (AEC scenario enhances opportunities for labor mobility from low-skilled labor countries, what challenges will be faced, and how this policy impacts their economies. The implementation of the AEC’s free movement of skilled labor policy is projected to face challenges such as mismatched labor qualifications, fulfilling ASEAN commitment, time for implementation of ASEAN commitments, and controlling the flow of illegal migrant workers. However, ASEAN leaders already set some supporting policies to overcome challenges from this system by improving labor market information, encouraging language and skills training, managing government and public supports, expanding mutual recognition arrangements and enhancing social protection for migrant workers. If these supporting policies can be implemented, the AEC’s free movement of skilled labor policy will improve the quality of human resources in ASEAN, especially from lower-middle income countries including Indonesia, Cambodia, Laos, Vietnam, the Philippines, and Thailand. As the results, those six countries are expected to increase the high-skilled employment rates by 0.3 to 1.4 percent and the wage rates up to 10-20 percent in 2025. Thus, the projected increases in the employment and wage rates of ASEAN skilled labor will induce an expansion of the ASEAN economic growth to 7.1 percent in 2025.

Finger-Based Numerical Skills Link Fine Motor Skills to Numerical Development in Preschoolers.

Science.gov (United States)

Suggate, Sebastian; Stoeger, Heidrun; Fischer, Ursula

2017-12-01

Previous studies investigating the association between fine-motor skills (FMS) and mathematical skills have lacked specificity. In this study, we test whether an FMS link to numerical skills is due to the involvement of finger representations in early mathematics. We gave 81 pre-schoolers (mean age of 4 years, 9 months) a set of FMS measures and numerical tasks with and without a specific finger focus. Additionally, we used receptive vocabulary and chronological age as control measures. FMS linked more closely to finger-based than to nonfinger-based numerical skills even after accounting for the control variables. Moreover, the relationship between FMS and numerical skill was entirely mediated by finger-based numerical skills. We concluded that FMS are closely related to early numerical skill development through finger-based numerical counting that aids the acquisition of mathematical mental representations.

A Cultured Learning Environment: Implementing a Problem- and Service-Based Microbiology Capstone Course to Assess Process- and Skill-Based Learning Objectives

Science.gov (United States)

Watson, Rachel M.; Willford, John D.; Pfeifer, Mariel A.

2018-01-01

In this study, a problem-based capstone course was designed to assess the University of Wyoming Microbiology Program's skill-based and process-based student learning objectives. Students partnered with a local farm, a community garden, and a free downtown clinic in order to conceptualize, propose, perform, and present studies addressing problems…

Precipitous Birth

Directory of Open Access Journals (Sweden)

Jennifer Yee

2017-09-01

Full Text Available Audience: This scenario was developed to educate emergency medicine residents on the management of a precipitous birth in the emergency department (ED. The case is also appropriate for teaching of medical students and advanced practice providers, as well as reviewing the principles of crisis resource management, teamwork, and communication. Introduction: Patients with precipitous birth require providers to manage two patients simultaneously with limited time and resources. Crisis resource management skills will be tested once baby is delivered, and the neonate will require assessment for potential neonatal resuscitation. Objectives: At the conclusion of the simulation session, learners will be able to manage women who have precipitous deliveries, as well as perform neonatal assessment and management. Method: This session was conducted using high-fidelity simulation, followed by a debriefing session and lecture on precipitous birth management and neonatal evaluation.

The high burden of infant deaths in rural Burkina Faso: a prospective community-based cohort study

Directory of Open Access Journals (Sweden)

Diallo Abdoulaye

2012-09-01

Full Text Available Abstract Background Infant mortality rates (IMR remain high in many sub-Saharan African countries, especially in rural settings where access to health services may be limited. Studies in such communities can provide relevant data on the burden of and risk factors for infant death. We measured IMR and explored risk factors for infant death in a cohort of children born in Banfora Health District, a rural area in South-West Burkina Faso. Methods A prospective community-based cohort study was nested within the PROMISE-EBF trial (NCT00397150 in 24 villages of the study area. Maternal and infant baseline characteristics were collected at recruitment and after birth, respectively. Home visits were conducted at weeks 3, 6, 12, 24 and 52 after birth. Descriptive statistics were calculated using robust standard errors to account for cluster sampling. Cox multivariable regression was used to investigate potential risk factors for infant death. Results Among the 866 live born children included in the study there were 98 infant deaths, yielding an IMR of 113 per 1000 live births (95% CI: 89–143. Over 75% of infant deaths had occurred by 6 months of age and the post neonatal infant mortality rate was 67 per 1000 live births (95% CI: 51–88. Infections (35% and preterm births complications (23% were the most common probable causes of death by 6 months. Multivariable analyses identified maternal history of child death, polygyny, twin births and poor anthropometric z-scores at week-3 as factors associated with increased risk of infant death. Conclusions We observed a very high IMR in a rural area of Burkina Faso, a country where 75% of the population lives in rural settings. Community-based health interventions targeting mothers and children at high risk are urgently needed to reduce the high burden of infant deaths in these areas.

The high burden of infant deaths in rural Burkina Faso: a prospective community-based cohort study.

Science.gov (United States)

Hama Diallo, Abdoulaye; Meda, Nicolas; Sommerfelt, Halvor; Traore, Germain S; Cousens, Simon; Tylleskar, Thorkild

2012-09-05

Infant mortality rates (IMR) remain high in many sub-Saharan African countries, especially in rural settings where access to health services may be limited. Studies in such communities can provide relevant data on the burden of and risk factors for infant death. We measured IMR and explored risk factors for infant death in a cohort of children born in Banfora Health District, a rural area in South-West Burkina Faso. A prospective community-based cohort study was nested within the PROMISE-EBF trial (NCT00397150) in 24 villages of the study area. Maternal and infant baseline characteristics were collected at recruitment and after birth, respectively. Home visits were conducted at weeks 3, 6, 12, 24 and 52 after birth. Descriptive statistics were calculated using robust standard errors to account for cluster sampling. Cox multivariable regression was used to investigate potential risk factors for infant death. Among the 866 live born children included in the study there were 98 infant deaths, yielding an IMR of 113 per 1000 live births (95% CI: 89-143). Over 75% of infant deaths had occurred by 6 months of age and the post neonatal infant mortality rate was 67 per 1000 live births (95% CI: 51-88). Infections (35%) and preterm births complications (23%) were the most common probable causes of death by 6 months. Multivariable analyses identified maternal history of child death, polygyny, twin births and poor anthropometric z-scores at week-3 as factors associated with increased risk of infant death. We observed a very high IMR in a rural area of Burkina Faso, a country where 75% of the population lives in rural settings. Community-based health interventions targeting mothers and children at high risk are urgently needed to reduce the high burden of infant deaths in these areas.

Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys.

Science.gov (United States)

Mezmur, Markos; Navaneetham, Kannan; Letamo, Gobopamang; Bariagaber, Hadgu

2017-01-01

Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS) conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005) and 624 (in the year 2011) communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and women in the

Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys.

Directory of Open Access Journals (Sweden)

Markos Mezmur

Full Text Available Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005 and 624 (in the year 2011 communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and

Birth preparedness, complication readiness and other determinants of place of delivery among mothers in Goba District, Bale Zone, South East Ethiopia.

Science.gov (United States)

Belda, Semere Sileshi; Gebremariam, Mulugeta Betre

2016-04-06

Ethiopia is one of the countries with the highest maternal mortality ratio 676/100,000 LB and the lowest skilled delivery at birth (10%) in 2011. Skilled delivery care and provision of emergency obstetric care prevents many of these deaths. Despite implementation of birth preparedness and complication readiness packages to antenatal care users since 2007 in the study area, yet an overwhelming proportion of births take place at home. The effect of birth preparedness and complication readiness on place of delivery is not well known and studied in this context. A community based case control study preceded by initial census was conducted on a total of 358 sampled respondents (119 cases and 239 controls) who were selected using stratified two stage sampling technique. A pre-tested and standardized questionnaire with a face-to-face interview was used to collect the data, and then data was cleaned, coded and entered in to SPSS version-21 for analysis. Binary logistic regression models were run to identify predictors of place of delivery and Odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. The mean (± Standard Deviation) age of respondents was; 27.41(±5.8) and 28.84(±5.7) years for the cases and the controls respectively. Two third (67.1%) of the childbirths took place in the respondents house while only (32.9%) gave birth in health facilities. Great proportion (79.7%) of the cases and two third (34.0%) of the controls were well-prepared for birth and complication. Maternal education, religion, distance from health facility, knowledge of availability of ambulance transport and history of obstetric complication were significantly associated with place of delivery (P-value delivery (AOR =2.55, 95% CI: 1.12, 5.84). The study identified better institutional delivery service utilization by mothers who were well-prepared for birth and complication. Strategies that increase the preparedness of mothers for birth and

Neighbourhood socioeconomic status and maternal factors at birth as moderators of the association between birth characteristics and school attainment: a population study of children attending government schools in Western Australia.

Science.gov (United States)

Malacova, E; Li, J; Blair, E; Mattes, E; de Klerk, N; Stanley, F

2009-10-01

This article investigates whether reading and writing skills among children of equivalent perinatal characteristics differ by neighbourhood socioeconomic status and maternal factors. Notifications of births for all non-Aboriginal singletons born in 1990-7 in Western Australia subsequently attending government primary schools were linked to the State literacy tests in grade three and with information on socioeconomic status of the school and the residential area. Using multilevel modelling, the associations between birth characteristics (gestational age, intrauterine growth, birth order and Apgar score at 5 minutes) and literacy attainment in grade three were examined in models that included socioeconomic and demographic factors of the child, mother and community. Higher percentages of optimal head circumference and birth length and term birth were positively and independently associated with literacy scores. A higher percentage of optimal birth weight was associated with higher reading scores especially for children born to mothers residing in educationally advantaged areas. First birth was positively associated with reading and writing attainment: this association was stronger for children born to single mothers and additional advantage in writing was also associated with first birth in children living in disadvantaged areas. These findings suggest that having suboptimal growth in utero or an older sibling at birth increases vulnerability to poor literacy attainment especially among children born to single mothers or those in disadvantaged neighbourhoods. These data provide evidence for advocating lifestyles compatible with optimum fetal growth and socioeconomic conditions conducive to healthy lifestyles, particularly during pregnancy.

Creation and validation of the Singapore birth nomograms for birth weight, length and head circumference based on a 12-year birth cohort.

Science.gov (United States)

Poon, Woei Bing; Fook-Chong, Stephanie M C; Ler, Grace Y L; Loh, Zhi Wen; Yeo, Cheo Lian

2014-06-01

Both gestation and birth weight have significant impact on mortality and morbidity in newborn infants. Nomograms at birth allow classification of infants into small for gestational age (SGA) and large for gestational age (LGA) categories, for risk stratification and more intensive monitoring. To date, the growth charts for preterm newborn infants in Singapore are based on the Fenton growth charts, which are constructed based on combining data from various Western growth cohorts. Hence, we aim to create Singapore nomograms for birth weight, length and head circumference at birth, which would reflect the norms and challenges faced by local infants. Growth parameters of all babies born or admitted to our unit from 2001 to 2012 were retrieved. Following exclusion of outliers, nomograms for 3 percentiles of 10th, 50th, and 90th were generated for the gestational age (GA) ranges of 25 to 42 weeks using quantile regression (QR) combined with the use of restricted cubic splines. Various polynomial models (second to third degrees) were investigated for suitability of fit. The optimum QR model was found to be a third degree polynomial with a single knotted cubic spline in the mid-point of the GA range, at 33.5 weeks. Check for goodness of fit was done by visual inspection first. Next, check was performed to ensure the correct proportion: 10% of all cases fall above the upper 90th percentile and 10% fall below the lower 10th percentile. Furthermore, an alternative formula-based method of nomogram construction, using mean, standard deviation (SD) and assumption of normality at each gestational age, was used for counterchecking. A total of 13,403 newborns were included in the analysis. The new infant-foetal growth charts with respect to birth weight, heel-crown length and occipitofrontal circumference from 25 to 42 weeks gestations with the 10th, 50th and 90th were presented. Nomograms for birth weight, length and head circumference at birth had significant impact on neonatal

End-of-life conversations and care: an asset-based model for community engagement.

Science.gov (United States)

Matthiesen, Mary; Froggatt, Katherine; Owen, Elaine; Ashton, John R

2014-09-01

Public awareness work regarding palliative and end-of-life care is increasingly promoted within national strategies for palliative care. Different approaches to undertaking this work are being used, often based upon broader educational principles, but little is known about how to undertake such initiatives in a way that equally engages both the health and social care sector and the local communities. An asset-based community engagement approach has been developed that facilitates community-led awareness initiatives concerning end-of-life conversations and care by identifying and connecting existing skills and expertise. (1) To describe the processes and features of an asset-based community engagement approach that facilitates community-led awareness initiatives with a focus on end-of-life conversations and care; and (2) to identify key community-identified priorities for sustainable community engagement processes. An asset-based model of community engagement specific to end-of-life issues using a four-step process is described (getting started, coming together, action planning and implementation). The use of this approach, in two regional community engagement programmes, based across rural and urban communities in the northwest of England, is described. The assets identified in the facilitated community engagement process encompassed people's talents and skills, community groups and networks, government and non-government agencies, physical and economic assets and community values and stories. Five priority areas were addressed to ensure active community engagement work: information, outreach, education, leadership and sustainability. A facilitated, asset-based approach of community engagement for end-of-life conversations and care can catalyse community-led awareness initiatives. This occurs through the involvement of community and local health and social care organisations as co-creators of this change across multiple sectors in a sustainable way. This approach

Use of simulated patients to assess the clinical and communication skills of community pharmacists.

Science.gov (United States)

Weiss, Marjorie C; Booth, Anneka; Jones, Bethan; Ramjeet, Sarah; Wong, Eva

2010-06-01

To investigate the quality and appropriateness of Emergency Hormonal Contraception (EHC) supply from community pharmacies. Community pharmacies in the southwest of England during 2007. Two simulated patient ('mystery shopper') scenarios to each participating pharmacy, one where the supply of EHC would be appropriate (scenario 1) and one where there was a drug interaction between EHC and St John's Wort, and the supply inappropriate (scenario 2). Pharmacy consultations were rated using criteria developed from two focus groups: one with pharmacist academics and one with female university students. Feedback to pharmacists to inform their continuing professional development was provided. Scores on rating scales encompassing the clinical and communication skills of the participating community pharmacists completed immediately after each mystery shopper visit. 40 pharmacist visits were completed: 21 for scenario 1 and 19 for scenario 2. Eighteen pharmacists were visited twice. Five pharmacists visited for scenario 2 supplied EHC against professional guidance, although other reference sources conflicted with this advice. Pharmacies which were part of the local PGD scheme scored higher overall in scenario 1 (P = 0.005) than those not part of the scheme. Overall the communication skills of pharmacists were rated highly although some pharmacists used jargon when explaining the interaction for scenario 2. Formatively assessing communication skills in an integrative manner alongside clinical skills has been identified as an important part of the medical consultation skills training and can be incorporated into the routine assessment and feedback of pharmacy over-the-counter medicines advice.

Fetal size monitoring and birth-weight prediction: a new population-based approach.

Science.gov (United States)

Gjessing, H K; Grøttum, P; Økland, I; Eik-Nes, S H

2017-04-01

To develop a complete, population-based system for ultrasound-based fetal size monitoring and birth-weight prediction for use in the second and third trimesters of pregnancy. Using 31 516 ultrasound examinations from a population-based Norwegian clinical database, we constructed fetal size charts for biparietal diameter, femur length and abdominal circumference from 24 to 42 weeks' gestation. A reference curve of median birth weight for gestational age was estimated using 45 037 birth weights. We determined how individual deviations from the expected ultrasound measures predicted individual percentage deviations from expected birth weight. The predictive quality was assessed by explained variance of birth weight and receiver-operating characteristics curves for prediction of small-for-gestational age. A curve for intrauterine estimated fetal weight was constructed. Charts were smoothed using the gamlss non-linear regression method. The population-based approach, using bias-free ultrasound gestational age, produces stable estimates of size-for-age and weight-for-age curves in the range 24-42 weeks' gestation. There is a close correspondence between percentage deviations and percentiles of birth weight by gestational age, making it easy to convert between the two. The variance of birth weight that can be 'explained' by ultrasound increases from 8% at 20 weeks up to 67% around term. Intrauterine estimated fetal weight is 0-106 g higher than median birth weight in the preterm period. The new population-based birth-weight prediction model provides a simple summary measure, the 'percentage birth-weight deviation', to be used for fetal size monitoring throughout the third trimester. Predictive quality of the model can be measured directly from the population data. The model computes both median observed birth weight and intrauterine estimated fetal weight. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John

Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study.

Science.gov (United States)

Lindgren, Helena E; Rådestad, Ingela J; Christensson, Kyllike; Hildingsson, Ingegerd M

2008-01-01

The aim of this population-based study was to measure the risk of adverse outcome for mother and child in planned home births in a Swedish population irrespective of where the birth actually occurred, at home or in hospital after transfer. A population-based study using data from the Swedish Medical Birth Register. Sweden 1992-2004. A total of 897 planned home births were compared with a randomly selected group of 11,341 planned hospital births. Prevalence of mortality and morbidity among mothers and children, emergency conditions, instrumental and operative delivery and perineal lacerations were compared. During this period in Sweden the neonatal mortality rate was 2.2 per thousand in the home birth group and 0.7 in the hospital group (RR 3.6, 95% CI 0.2-14.7). No cases of emergency complications were found in the home birth group. The risk of having a sphincter rupture was lower in the planned home birth group (RR 0.2, 95% CI 0.0-0.7). The risk of having a cesarean section (RR 0.4, 95% CI 0.2-0.7) or instrumental delivery (RR 0.3, 95% CI 0.2-0.5) was significantly lower in the planned home birth group. In Sweden, between 1992 and 2004, the intrapartum and neonatal mortality in planned home births was 2.2 per thousand. The proportion is higher compared to hospital births but no statistically significant difference was found. Women in the home birth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.

A model for partnering first-year student pharmacists with community-based older adults.

Science.gov (United States)

Martin, Beth A; Porter, Andrea L; Shawl, Lauren; Motl Moroney, Susannah E

2012-06-18

To design, integrate, and assess the effectiveness of an introductory pharmacy practice experience intended to redefine first-year student pharmacists' views on aging and medication use through their work with a healthy, community-based older-adult population. All students (N = 273) completed live skills training in an 8-hour boot camp provided during orientation week. Teams were assigned an independently living senior partner, completed 10 visits and reflections, and documented health-related information using an electronic portfolio (e-portfolio). As determined by pre- and post-experience survey instruments, students gained significant confidence in 7 skill areas related to communication, medication interviews, involving the partner in health care, and applying patient-care skills. Student reflections, in-class presentations, and e-portfolios documented that personal attitudes toward seniors changed over time. Senior partners enjoyed mentoring and interacting with students and many experienced health improvements as a result of the interaction. The model for partnering first-year student pharmacists with community-based older adults improved students' skills and fostered their connections to pharmacist roles and growth as person-centered providers.

Feasibility of pulse oximetry for assessment of infants born in community based midwifery care

NARCIS (Netherlands)

Smit, M.; Ganzeboom, A.; Dawson, J.A.; Walther, F.J.; Bustraan, J.; van Roosmalen, Jos; te Pas, A.B.

2014-01-01

To evaluate the feasibility of using pulse oximetry (PO) for evaluating infants born in community-based midwifery care. Design: a prospective, observational study of infants born after midwifery supervised (home) births. Setting: 27 midwives from seven practices providing primary care in (home)

Community of Inquiry Method and Language Skills Acquisition: Empirical Evidence

Science.gov (United States)

Preece, Abdul Shakhour Duncan

2015-01-01

The study investigates the effectiveness of community of inquiry method in preparing students to develop listening and speaking skills in a sample of junior secondary school students in Borno state, Nigeria. A sample of 100 students in standard classes was drawn in one secondary school in Maiduguri metropolis through stratified random sampling…

What's Working: Program Factors Influencing California Community College Basic Skills Mathematics Students' Advancement to Transfer Level

Science.gov (United States)

Fiero, Diane M.

2013-01-01

Purpose: The purpose of this study was to determine which basic skills program factors were exhibited by successful basic skills programs that helped students advance to transfer-level mathematics. This study specifically examined California community college basic skills programs that assist students who place in mathematics courses 2 levels…

Do the early development of gestures and receptive and expressive language predict language skills at 5;0 in prematurely born very-low-birth-weight children?

Science.gov (United States)

Stolt, S; Lind, A; Matomäki, J; Haataja, L; Lapinleimu, H; Lehtonen, L

2016-01-01

It is unclear what the predictive value of very early development of gestures and language is on later language ability in prematurely born very-low-birth-weight (VLBW; birth weight ≤1500g) children. The aim of the present study was to analyse the predictive value of early gestures and a receptive lexicon measured between the ages of 0;9 and 1;3, as well as the predictive value of receptive and expressive language ability at 2;0 for language skills at 5;0 in VLBW children. The subjects were 29 VLBW children and 28 full-term children whose language development has been followed intensively between the ages of 0;9 and 2;0 using the Finnish version of the MacArthur Developmental Inventory and the Reynell Developmental Language Scales (RDLS III). At 5;0, five selected verbal subtests of the Nepsy II test and the Boston Naming Test (BNT) were used to assess children's language skills. For the first time in VLBW children, the development of gestures measured between the ages of 0;9 and 1;3 was shown to correlate significantly and positively with language skills at 5;0. In addition, both receptive and expressive language ability measured at 2;0 correlated significantly and positively with later language skills in both groups. Moreover, according to the hierarchical regression analysis, the receptive language score of the RDLS III at 2;0 was a clear and significant predictor for language skills at 5;0 in both groups. The findings particularly underline the role of early receptive language as a significant predictor for later language ability in VLBW children. The results provide evidence for a continuity between early language development and later language skills. After reading this article, readers will understand the associations between the very early (≤2 years of age) development of gestures and language (i.e. early receptive lexicon, expressive lexicon at 2;0, receptive and expressive language ability at 2;0) and the language skills at 5;0 in prematurely born

Social Entrepreneurship Andragogy-Based for Community Empowerment

Directory of Open Access Journals (Sweden)

Hidayat Dayat

2018-01-01

Full Text Available The essence of social entrepreneurship is the ability to initiate, lead and implement problem-solving strategies, through cooperation with others in all types of social networks. The purpose of this study analyzes: 1 entrepreneurship training, 2 adult education assumptions, and 3 community empowerment. This study is discussed by using a comparative theory analysis method that related to entrepreneurship training, andragogy, and community empowerment from various literary sources. Analysis is conducted to find conclusions that can be justified scientifically. The results of the study conclude that: 1 social entrepreneurship training is an organized learning process from planning, implementation, and evaluation on non-formal education path aimed at enhancing community knowledge, attitude and skills for learning and endeavor, 2 entrepreneurship training based on andragogy conducted through a learning process that implements adults’ assumptions of self-conceptual, learning experiences, learning readiness, and learning orientation. 3 Community empowerment is a process of empowerment or strength to community to have the ability of individuals who completely agreed with the community in building social and economic empowerment of the community.

Low-birth-weight babies among hospital deliveries in Nepal: a hospital-based study

Directory of Open Access Journals (Sweden)

Koirala AK

2015-06-01

Full Text Available Arun K Koirala,1 Dharma N Bhatta2,3 1Administrative Department, Helping Hands Community Hospital, Chabahil, Kathmandu, 2Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal; 3Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand Background: Birth weight is an important indicator of a population’s health and is associated with numerous interrelated factors in the infant, mother, and physical environment. The objective of this study was to assess the proportion of low birth weight and identify the associated factors for low birth weight in a liveborn infant among the women in Morang, Nepal.Methods: A cross-sectional survey was carried out from December 2010 to March 2011 among 255 mothers who gave birth during the study period at the Koshi Zonal Hospital, Nepal. Data were collected using a structured questionnaire with face-to-face interviews. Data were analyzed through logistic regression and presented with crude and adjusted odds ratios (AORs with 95% confidence intervals (CIs.Results: The study showed that the prevalence of low-birth-weight babies was 23.1% (95% CI: 17.9–28.1. The mean (standard deviation age of mothers was 23.23 (4.18 years. The proportion of low birth weight of previous baby was 3.9% (95% CI: 0.1–7.9, and 15.7% (95% CI: 11.5–20.5 of the respondents had preterm delivery. Nearly one-third (36.1%; 95% CI: 26.4–45.6 of the respondents had >2 years’ gap after the previous delivery. Nonformal employment (AOR: 2.14; 95% CI: 0.523–8.74, vegetarian diet (AOR: 1.47; 95% CI: 0.23–9.36, and no rest during pregnancy (AOR: 1.38; 95% CI: 0.41–4.39 were factors more likely to determine low birth weight. However, none of the variables showed a significant association between low birth weight and other dependent variables.Conclusion: Low birth weight is an important factor for perinatal morbidity and mortality and is a common problem in the developing world. The

Lecturing skills as predictors of tutoring skills in a problem-based medical curriculum.

Science.gov (United States)

Kassab, Salah Eldin; Hassan, Nahla; Abu-Hijleh, Marwan F; Sequeira, Reginald P

2016-01-01

Recruitment of tutors to work in problem-based learning (PBL) programs is challenging, especially in that most of them are graduated from discipline-based programs. Therefore, this study aims at examining whether lecturing skills of faculty could predict their PBL tutoring skills. This study included evaluation of faculty (n=69) who participated in both tutoring and lecturing within particular PBL units at the College of Medicine and Medical Sciences (CMMS), Arabian Gulf University, Bahrain. Each faculty was evaluated by medical students (n=45±8 for lecturing and 8±2 for PBL tutoring) using structured evaluation forms based on a Likert-type scale (poor to excellent). The prediction of tutoring skills using lecturing skills was statistically analyzed using stepwise linear regression. Among the parameters used to judge lecturing skills, the most important predictor for tutoring skills was subject matter mastery in the lecture by explaining difficult concepts and responding effectively to students' questions. Subject matter mastery in the lecture positively predicted five tutoring skills and accounted for 25% of the variance in overall effectiveness of the PBL tutors (F=22.39, P=0.000). Other important predictors for tutoring skills were providing a relaxed class atmosphere and effective use of audiovisual aids in the lecture. Predicting the tutoring skills based on lecturing skills could have implications for recruiting tutors in PBL medical programs and for tutor training initiatives.

Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia.

Science.gov (United States)

Pagel, Christina; Prost, Audrey; Hossen, Munir; Azad, Kishwar; Kuddus, Abdul; Roy, Swati Sarbani; Nair, Nirmala; Tripathy, Prasanta; Saville, Naomi; Sen, Aman; Sikorski, Catherine; Manandhar, Dharma S; Costello, Anthony; Crowe, Sonya

2014-03-07

Provision of essential newborn care (ENC) can save many newborn lives in poor resource settings but coverage is far from universal and varies by country and place of delivery. Understanding gaps in current coverage and where coverage is good, in different contexts and places of delivery, could make a valuable contribution to the future design of interventions to reduce neonatal mortality. We sought to describe the coverage of essential newborn care practices for births in institutions, at home with a skilled birth attendant, and at home without a skilled birth attendant (SBA) in rural areas of Bangladesh, Nepal, and India. We used data from the control arms of four cluster randomised controlled trials in Bangladesh, Eastern India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used these data to identify essential newborn care practices as defined by the World Health Organization. Each birth was allocated to one of three delivery types: home birth without an SBA, home birth with an SBA, or institutional delivery. For each study, we calculated the observed proportion of births that received each care practice by delivery type with 95% confidence intervals, adjusted for clustering and, where appropriate, stratification. After exclusions, we analysed data for 8939 births from Eastern India, 27 553 births from Bangladesh, 6765 births from Makwanpur and 15 344 births from Dhanusha. Across all study areas, coverage of essential newborn care practices was highest in institutional deliveries, and lowest in home non-SBA deliveries. However, institutional deliveries did not provide universal coverage of the recommended practices, with relatively low coverage (20%-70%) across all study areas for immediate breastfeeding and thermal care. Institutions in Bangladesh had the highest coverage for almost all care practices except thermal care. Across all areas, fewer than 20% of home non-SBA deliveries used a clean delivery kit, the use of

The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomised trial.

Science.gov (United States)

Magoma, Moke; Requejo, Jennifer; Campbell, Oona; Cousens, Simon; Merialdi, Mario; Filippi, Veronique

2013-04-01

To determine the effectiveness of birth plans in increasing use of skilled care at delivery and in the postnatal period among antenatal care (ANC) attendees in a rural district with low occupancy of health units for delivery but high antenatal care uptake in northern Tanzania. Cluster randomised trial in Ngorongoro district, Arusha region, involving 16 health units (8 per arm). Nine hundred and five pregnant women at 24 weeks of gestation and above (404 in the intervention arm) were recruited and followed up to at least 1 month postpartum. Skilled delivery care uptake was 16.8% higher in the intervention units than in the control [95% CI 2.6-31.0; P = 0.02]. Postnatal care utilisation in the first month of delivery was higher (difference in proportions: 30.0% [95% CI 1.3-47.7; P < 0.01]) and also initiated earlier (mean duration 6.6 ± 1.7 days vs. 20.9 ± 4.4 days, P < 0.01) in the intervention than in the control arm. Women's and providers' reports of care satisfaction (received or provided) did not differ greatly between the two arms of the study (difference in proportion: 12.1% [95% CI -6.3-30.5] P = 0.17 and 6.9% [95% CI -3.2-17.1] P = 0.15, respectively). Implementation of birth plans during ANC can increase the uptake of skilled delivery and post delivery care in the study district without negatively affecting women's and providers' satisfaction with available ANC services. Birth plans should be considered along with the range of other recommended interventions as a strategy to improve the uptake of maternal health services. © 2013 Blackwell Publishing Ltd.

The effectiveness of a community-based fundamental motor skill intervention in children aged 3-8 years: Results of the "Multimove for Kids" project.

Science.gov (United States)

Bardid, Farid; Lenoir, Matthieu; Huyben, Floris; De Martelaer, Kristine; Seghers, Jan; Goodway, Jacqueline D; Deconinck, Frederik J A

2017-02-01

The purpose of this study was to examine the effectiveness of a 30-week fundamental motor skill program in typically developing young children and to investigate possible sex differences. A multicenter quasi experimental design was set up for this study which involved 992 children aged 3-8 years. All participants received their typical Physical Education curriculum and habitual movement activities. The intervention group (n=523; 53.5% boys) received a weekly 60-min motor skill session provided by trained local instructors in existing child settings; the control group (n=469; 49.7% boys) received no additional practice. Fundamental motor skills were assessed using the Test of Gross Motor Development, 2nd Edition before and after the intervention. To assess the effect of the intervention and possible sex differences, hierarchical linear regressions analyses were conducted for locomotor and object control gain scores. The intervention group demonstrated a higher gain in both locomotor (β=3.78, SE=1.08, pskills than the control group. Girls demonstrated a lower gain in object control skills (β=-3.50, SE=0.49, pskills (β=1.01, SE=0.44, p=0.022) than boys, regardless of group. The present study demonstrated the effectiveness of a wide-scale community-based intervention in typically developing children. The sex differences reported may indicate the need to use different pedagogical and instructional strategies to enable boys and girls to develop and master a wide range of motor skills. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Simulation and Community-Based Instruction of Vending Machines with Time Delay.

Science.gov (United States)

Browder, Diane M.; And Others

1988-01-01

The study evaluated the use of simulated instruction on vending machine use as an adjunct to community-based instruction with two moderately retarded children. Results showed concurrent acquisition of the vending machine skills across trained and untrained sites. (Author/DB)

Is attendant at delivery associated with the use of interventions to prevent postpartum hemorrhage at home births? The case of Bangladesh.

Science.gov (United States)

Prata, Ndola; Bell, Suzanne; Holston, Martine; Quaiyum, Mohammad A

2014-01-16

Hemorrhage is the leading cause of maternal mortality in Bangladesh, the majority of which is due to postpartum hemorrhage (PPH), blood loss of 500 mL or more. Many deaths due to PPH occur at home where approximately 77% of births take place. This paper aims to determine whether the attendant at home delivery (i.e. traditional birth attendant (TBA) trained on PPH interventions, TBA not trained on interventions, or lay attendant) is associated with the use of interventions to prevent PPH at home births. Data come from operations research to determine the safety, feasibility, and acceptability of scaling-up community-based provision of misoprostol and an absorbent delivery mat in rural Bangladesh. Analyses were done using data from antenatal care (ANC) cards of women who delivered at home without a skilled attendant (N =66,489). Multivariate logistic regression was used to assess the likelihood of using the interventions. Overall, 67% of women who delivered at home without a skilled provider used misoprostol and the delivery mat (the interventions). Women who delivered at home and had a trained TBA present had 2.72 (95% confidence interval, 2.15-3.43) times the odds of using the interventions compared to those who had a lay person present. With each additional ANC visit (maximum of 4) a woman attended, the odds of using the interventions increased 2.76 times (95% confidence interval, 2.71-2.81). Other sociodemographic variables positively associated with use of the interventions were age, secondary or higher education, and having had a previous birth. Findings indicate that trained TBAs can have a significant impact on utilization of interventions to prevent PPH in home births. ANC visits can be an important point of contact for knowledge transfer and message reinforcement about PPH prevention.

Reduced Disparities in Birth Rates Among Teens

Science.gov (United States)

... Teens Winnable Battles Social Media at CDC Reduced Disparities in Birth Rates among Teens Aged 15–19 ... Pregnancy Prevention Community-Wide Initiative. National Rates and Disparities Nationally, the teen birth rate (number of births ...

Engaging Street Youth in an Evaluation of a Community-Based Arts Program

Directory of Open Access Journals (Sweden)

Robin Wright

2008-06-01

Full Text Available Data from the Edmonton Arts & Youth Feasibility Study (EAYFS was used to ascertain the feasibility of engaging street youth in a structured community-based arts program and an outcome-based evaluation. The study engaged 23 street youth in a ten-week multi-media arts program focused on developing prosocial communication, team-building, and problem-solving skills. Results have shown that street youth are highly interested in artistic endeavors; will participate to the best of their circumstances; and will provide reliable data. The youth and staff reported improved art skills, problem-solving capacity, and prosocial communication as well as a decrease in drug use, depression, loneliness, and a greater sense of enjoyment about life. Strengths of the program included the arts media, the non-judgmental environment, and the support from staff. The study suggests that community-based arts programs for street youth could be subjected to a rigorous outcome-based evaluation.

Racial/Ethnic Differences in Kindergartners' Reading and Math Skills: Parents' Knowledge of Children's Development and Home-Based Activities as Mediators

Science.gov (United States)

Sonnenschein, Susan; Sun, Shuyan

2017-01-01

Despite the growing body of research on parents' beliefs and practices, relatively little is known about the relations between parents' knowledge of children's development, home-based activities, and children's early reading and math skills. This study used data from the Early Childhood Longitudinal Study-Birth Cohort to examine the differences in…

Community/public health nursing faculty's knowledge, skills and attitudes of the Quad Council Competencies for Public Health Nurses.

Science.gov (United States)

Joyce, Barbara L; Harmon, Monica; Johnson, Regina Gina H; Hicks, Vicki; Brown-Schott, Nancy; Pilling, Lucille; Brownrigg, Vicki

2018-05-02

A multisite collaborative team of community/public health nursing (C/PHN) faculty surveyed baccalaureate nursing faculty to explore their knowledge, skills, attitudes, and application of the Quad Council Competencies for Public Health Nurses (QCC-PHN). (1) Evaluate the knowledge, skills, and attitudes of the 2011 QCC-PHN by academic C/PHN faculty; (2) Evaluate the application of 2011 QCC-PHN by C/PHN faculty in the clinical practicum for undergraduate baccalaureate C/PHN students; and (3) Determine if a significant difference existed in the knowledge for each domain. A mixed methods descriptive research design was used to answer three specific hypotheses related to the study objectives. A convenience sample of 143 faculty teaching C/PHN in baccalaureate schools of nursing completed an online survey. ANOVA was used to determine the difference between knowledge, skills, attitudes, and application of nursing faculty regarding the QCC-PHN based on years of nursing experience, C/PHN experience, and nursing specialty preparation. Participants' qualitative comments for each domain were analyzed for themes. C/PHN nursing faculty are described and differences in knowledge, skills, and attitudes delineated. A statistically significant difference was found in skills based on years of experience in C/PHN and in the application of the competencies based on nursing specialty preparation. Variations in knowledge of the QCC-PHN are identified. Ten recommendations are proposed for key skill sets and necessary preparation for faculty to effectively teach C/PHN in baccalaureate schools of nursing. © 2018 Wiley Periodicals, Inc.

Lecturing skills as predictors of tutoring skills in a problem-based medical curriculum

Directory of Open Access Journals (Sweden)

Kassab SE

2016-01-01

Full Text Available Salah Eldin Kassab,1 Nahla Hassan,1 Marwan F Abu-Hijleh,2 Reginald P Sequeira3 1Department of Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; 2College of Medicine, Qatar University, Doha, Qatar; 3College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain Purpose: Recruitment of tutors to work in problem-based learning (PBL programs is challenging, especially in that most of them are graduated from discipline-based programs. Therefore, this study aims at examining whether lecturing skills of faculty could predict their PBL tutoring skills. Methods: This study included evaluation of faculty (n=69 who participated in both tutoring and lecturing within particular PBL units at the College of Medicine and Medical Sciences (CMMS, Arabian Gulf University, Bahrain. Each faculty was evaluated by medical students (n=45±8 for lecturing and 8±2 for PBL tutoring using structured evaluation forms based on a Likert-type scale (poor to excellent. The prediction of tutoring skills using lecturing skills was statistically analyzed using stepwise linear regression. Results: Among the parameters used to judge lecturing skills, the most important predictor for tutoring skills was subject matter mastery in the lecture by explaining difficult concepts and responding effectively to students' questions. Subject matter mastery in the lecture positively predicted five tutoring skills and accounted for 25% of the variance in overall effectiveness of the PBL tutors (F=22.39, P=0.000. Other important predictors for tutoring skills were providing a relaxed class atmosphere and effective use of audiovisual aids in the lecture. Conclusion: Predicting the tutoring skills based on lecturing skills could have implications for recruiting tutors in PBL medical programs and for tutor training initiatives. Keywords: PBL, tutor, tutoring skills, lecturing skills

Community senior first aid training in Western Australia: its extent and effect on knowledge and skills.

Science.gov (United States)

Lynch, Dania M; Gennat, Hanni C; Celenza, Tony; Jacobs, Ian G; O'Brien, Debra; Jelinek, George A

2006-04-01

To define the extent of Senior First Aid training in a sample of the Western Australian community, and to evaluate the effect of previous training on first aid knowledge and skills. A telephone survey of a random sample from suburban Perth and rural Western Australia; and practical assessment of first aid skills in a subsample of those surveyed. 30.4% of respondents had completed a Senior First Aid certificate. Trained individuals performed consistently better in theoretical tests (p=0.0001) and practical management of snakebite (p=0.021) than untrained. However, many volunteers, both trained and untrained, demonstrated poor skills in applying pressure immobilisation bandaging and splinting the limb adequately despite electing to do so in theory. Overall knowledge and performance of first aid skills by the community are poor, but are improved by first aid training courses.

Community-based faculty: motivation and rewards.

Science.gov (United States)

Fulkerson, P K; Wang-Cheng, R

1997-02-01

The reasons why practicing physicians precept students in their offices, and the rewards they wish to receive for this work, have not been clearly elucidated. This study determined the reasons for precepting and the rewards expected among a network of preceptors in Milwaukee. A questionnaire was mailed to 120 community-based physician preceptors in a required, third-year ambulatory care clerkship. Respondents were asked to identify why they volunteered and what they considered appropriate recognition or reward. The personal satisfaction derived from the student-teacher interaction was, by far, the most important motivator for preceptors (84%). The most preferred rewards for teaching included clinical faculty appointment, CME and bookstore discounts, computer networking, and workshops for improving skills in clinical teaching. Community-based private physicians who participate in medical student education programs are primarily motivated by the personal satisfaction that they derive from the teaching encounter. An effective preceptor recognition/reward program can be developed using input from the preceptors themselves.

Comparison of Knowledge on Diarrheal Disease Management between Two Types of Community-Based Distributors in Oyo State, Nigeria

Science.gov (United States)

Ande, Oluyinka; Oladepo, Oladimeji; Brieger, William R.

2004-01-01

Community-based distributors (CBDs) have been trained and utilized to promote a variety of health commodities. In addition, a variety of different types of community residents have been trained ranging from traditional birth attendants (TBAs) to patent medicine vendors. A training programme for CBD agents in the Akinyele Local Government Area of…

Preventing Repeat Teen Births PSA (:60)

Centers for Disease Control (CDC) Podcasts

2013-04-02

This 60 second public service announcement is based on the April 2013 CDC Vital Signs report, which discusses repeat teen births and ways teens, parents and guardians, health care providers, and communities can help prevent them.  Created: 4/2/2013 by Centers for Disease Control and Prevention (CDC).   Date Released: 4/2/2013.

Promoting physical activity among youth through community-based prevention marketing.

Science.gov (United States)

Bryant, Carol A; Courtney, Anita H; McDermott, Robert J; Alfonso, Moya L; Baldwin, Julie A; Nickelson, Jen; McCormack Brown, Kelli R; Debate, Rita D; Phillips, Leah M; Thompson, Zachary; Zhu, Yiliang

2010-05-01

Community-based prevention marketing (CBPM) is a program planning framework that blends community-organizing principles with a social marketing mind-set to design, implement, and evaluate public health interventions. A community coalition used CBPM to create a physical activity promotion program for tweens (youth 9-13 years of age) called VERB Summer Scorecard. Based on the national VERB media campaign, the program offered opportunities for tweens to try new types of physical activity during the summer months. The VERB Summer Scorecard was implemented and monitored between 2004 and 2007 using the 9-step CBPM framework. Program performance was assessed through in-depth interviews and a school-based survey of youth. The CBPM process and principles used by school and community personnel to promote physical activity among tweens are presented. Observed declines may become less steep if school officials adopt a marketing mind-set to encourage youth physical activity: deemphasizing health benefits but promoting activity as something fun that fosters spending time with friends while trying and mastering new skills. Community-based programs can augment and provide continuity to school-based prevention programs to increase physical activity among tweens.

Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration.

Science.gov (United States)

Sarker, Bidhan Krishna; Rahman, Musfikur; Rahman, Tawhidur; Hossain, Jahangir; Reichenbach, Laura; Mitra, Dipak Kumar

2016-01-01

Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014-2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA) in rural areas of Bangladesh. This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII) with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI) with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community. The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities. The study findings provide us a better understanding of the reasons for preference for home delivery with TBA among this

Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs in Rural Bangladesh: A Qualitative Exploration.

Directory of Open Access Journals (Sweden)

Bidhan Krishna Sarker

Full Text Available Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014-2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA in rural areas of Bangladesh.This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community.The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities.The study findings provide us a better understanding of the reasons for preference for home delivery with TBA

Early pregnancy vaginal microbiome trends and preterm birth.

Science.gov (United States)

Stout, Molly J; Zhou, Yanjiao; Wylie, Kristine M; Tarr, Phillip I; Macones, George A; Tuuli, Methodius G

2017-09-01

Despite decades of attempts to link infectious agents to preterm birth, an exact causative microbe or community of microbes remains elusive. Nonculture 16S ribosomal RNA gene sequencing suggests important racial differences and pregnancy specific changes in the vaginal microbial communities. A recent study examining the association of the vaginal microbiome and preterm birth documented important findings but was performed in a predominantly white cohort. Given the important racial differences in bacterial communities within the vagina as well as persistent racial disparities in preterm birth, it is important to examine cohorts with varied demographic compositions. To characterize vaginal microbial community characteristics in a large, predominantly African-American, longitudinal cohort of pregnant women and test whether particular vaginal microbial community characteristics are associated with the risk for subsequent preterm birth. This is a nested case-control study within a prospective cohort study of women with singleton pregnancies, not on supplemental progesterone, and without cervical cerclage in situ. Serial mid-vaginal swabs were obtained by speculum exam at their routine prenatal visits. Sequencing of the V1V3 region of the 16S rRNA gene was performed on the Roche 454 platform. Alpha diversity community characteristics including richness, Shannon diversity, and evenness as well as beta diversity metrics including Bray Curtis Dissimilarity and specific taxon abundance were compared longitudinally in women who delivered preterm to those who delivered at term. A total of 77 subjects contributed 149 vaginal swabs longitudinally across pregnancy. Participants were predominantly African-American (69%) and had a preterm birth rate of 31%. In subjects with subsequent term delivery, the vaginal microbiome demonstrated stable community richness and Shannon diversity, whereas subjects with subsequent preterm delivery had significantly decreased vaginal richness

Missed opportunities for institutional delivery and associated factors among urban resident pregnant women in South Tigray Zone, Ethiopia: a community-based follow-up study.

Science.gov (United States)

Bayu, Hinsermu; Fisseha, Girmastion; Mulat, Amlaku; Yitayih, Gebre; Wolday, Mengistu

2015-01-01

Every pregnant woman is considered to be at risk and some risks may not always be foreseeable or detectable. Therefore, the presence of a skilled birth attendant at every delivery is considered to be the most critical intervention in reducing maternal mortality and morbidity. In Ethiopia, the proportion of births attended by skilled personnel in urban settings can be as low as 10%. Therefore, the main purpose of this research was to identify factors affecting unplanned home delivery in urban settings, where there is relatively good access in principle to modern healthcare institutions. A community-based follow-up study was conducted from 17 January 2014 to 30 August 2014, among second- and third-trimester pregnant women who had planned for institutional delivery in South Tigray Zone. A systematic sampling technique was used to get a total of 522 study participants. A pre-tested and structured questionnaire was used to collect relevant data. Bivariate and multivariate data analyses were performed using SPSS version 16.0. The study revealed that among 465 pregnant women who planned for institutional delivery, 134 (28.8%) opted out and delivered at their home (missed opportunity). Single women (AOR 2.34, 95% CI 1.17-4.68), illiterate mothers (AOR 6.14, 95% CI 2.20-17.2), absence of antenatal clinic visit for indexed pregnancy (AOR 3.11, 95% CI 1.72-5.61), absence of obstetric complications during the index pregnancy (AOR 2.96, 95% CI 1.47-5.97), poor autonomy (AOR 2.11, 95% CI 1.27-3.49), and absence of birth preparedness and complication readiness (AOR 3.83, 95% CI 2.19-6.70) were significant predictors of unplanned home delivery. A significant proportion of pregnant women missed the opportunity of modern delivery assistance. Educational status, antenatal care status, lack of obstetric complications, poor autonomy, and lack of birth preparedness and complication readiness were among the important predictors of unplanned home delivery.

Missed opportunities for institutional delivery and associated factors among urban resident pregnant women in South Tigray Zone, Ethiopia: a community-based follow-up study

Directory of Open Access Journals (Sweden)

Hinsermu Bayu

2015-09-01

Full Text Available Background: Every pregnant woman is considered to be at risk and some risks may not always be foreseeable or detectable. Therefore, the presence of a skilled birth attendant at every delivery is considered to be the most critical intervention in reducing maternal mortality and morbidity. In Ethiopia, the proportion of births attended by skilled personnel in urban settings can be as low as 10%. Therefore, the main purpose of this research was to identify factors affecting unplanned home delivery in urban settings, where there is relatively good access in principle to modern healthcare institutions. Design: A community-based follow-up study was conducted from 17 January 2014 to 30 August 2014, among second- and third-trimester pregnant women who had planned for institutional delivery in South Tigray Zone. A systematic sampling technique was used to get a total of 522 study participants. A pre-tested and structured questionnaire was used to collect relevant data. Bivariate and multivariate data analyses were performed using SPSS version 16.0. Results: The study revealed that among 465 pregnant women who planned for institutional delivery, 134 (28.8% opted out and delivered at their home (missed opportunity. Single women (AOR 2.34, 95% CI 1.17–4.68, illiterate mothers (AOR 6.14, 95% CI 2.20–17.2, absence of antenatal clinic visit for indexed pregnancy (AOR 3.11, 95% CI 1.72–5.61, absence of obstetric complications during the index pregnancy (AOR 2.96, 95% CI 1.47–5.97, poor autonomy (AOR 2.11, 95% CI 1.27–3.49, and absence of birth preparedness and complication readiness (AOR 3.83, 95% CI 2.19–6.70 were significant predictors of unplanned home delivery. Conclusions: A significant proportion of pregnant women missed the opportunity of modern delivery assistance. Educational status, antenatal care status, lack of obstetric complications, poor autonomy, and lack of birth preparedness and complication readiness were among the important

Why do women prefer home births in Ethiopia?

Directory of Open Access Journals (Sweden)

Shiferaw Solomon

2013-01-01

Full Text Available Abstract Background Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost. Methods The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15–49 year old women combined with in-depth interviews and focus group discussions. Results Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78% was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42% and not customary (36%, followed by high cost (22% and distance or lack of transportation (8%. The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women’s low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want, and economic constraints during referral contribute to the low level of service utilization. Conclusions The study

Why do women prefer home births in Ethiopia?

Science.gov (United States)

Shiferaw, Solomon; Spigt, Mark; Godefrooij, Merijn; Melkamu, Yilma; Tekie, Michael

2013-01-16

Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost. The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15-49 year old women combined with in-depth interviews and focus group discussions. Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife) for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78%) was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42%) and not customary (36%), followed by high cost (22%) and distance or lack of transportation (8%). The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women's low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want), and economic constraints during referral contribute to the low level of service utilization. The study indicated the crucial role of proper health care provider

Implementation of science process skills using ICT-based approach to facilitate student life skills

Science.gov (United States)

Rahayu, Y. S.; Yuliani; Wijaya, B. R.

2018-01-01

The purpose of this study is to describe the results of the implementation of a teaching-learning package in Plant Physiology courses to improve the student’s life skills using the science process skills-based approach ICT. This research used 15 students of Biology Education of Undergraduate International Class who are in the Plant Physiology course. This study consists of two phases items, namely the development phase and implementation phase by using a one-shot case study design. Research parameters were the feasibility of lesson plans, student achievement, Including academic skills, thinking skills, and social skills. Data were descriptively Analyzed According to the characteristics of the existing data. The result shows that the feasibility of a lesson plan is very satisfied and can be improvements in student’s life skills, especially with regards to student’s thinking skills and scientific thinking skills. The results indicate that the science process skills using ICT-based approach can be effective methods to improve student’s life skills.

Evaluating clinical simulations for learning procedural skills: a theory-based approach.

Science.gov (United States)

Kneebone, Roger

2005-06-01

Simulation-based learning is becoming widely established within medical education. It offers obvious benefits to novices learning invasive procedural skills, especially in a climate of decreasing clinical exposure. However, simulations are often accepted uncritically, with undue emphasis being placed on technological sophistication at the expense of theory-based design. The author proposes four key areas that underpin simulation-based learning, and summarizes the theoretical grounding for each. These are (1) gaining technical proficiency (psychomotor skills and learning theory, the importance of repeated practice and regular reinforcement), (2) the place of expert assistance (a Vygotskian interpretation of tutor support, where assistance is tailored to each learner's needs), (3) learning within a professional context (situated learning and contemporary apprenticeship theory), and (4) the affective component of learning (the effect of emotion on learning). The author then offers four criteria for critically evaluating new or existing simulations, based on the theoretical framework outlined above. These are: (1) Simulations should allow for sustained, deliberate practice within a safe environment, ensuring that recently-acquired skills are consolidated within a defined curriculum which assures regular reinforcement; (2) simulations should provide access to expert tutors when appropriate, ensuring that such support fades when no longer needed; (3) simulations should map onto real-life clinical experience, ensuring that learning supports the experience gained within communities of actual practice; and (4) simulation-based learning environments should provide a supportive, motivational, and learner-centered milieu which is conducive to learning.

Birth defects and genetic disorders among Arab Americans--Michigan, 1992-2003.

Science.gov (United States)

Yanni, Emad A; Copeland, Glenn; Olney, Richard S

2010-06-01

Birth defects and genetic disorders are leading causes of infant morbidity and mortality in many countries. Population-based data on birth defects among Arab-American children have not been documented previously. Michigan has the second largest Arab-American community in the United States after California. Using data from the Michigan Birth Defects Registry (MBDR), which includes information on parents' country of birth and ancestry, birth prevalences were estimated in offspring of Michigan women of Arab ancestry for 21 major categories of birth defects and 12 congenital endocrine, metabolic, and hereditary disorders. Compared with other non-Hispanic white children in Michigan, Arab-American children had similar or lower birth prevalences of the selected types of structural birth defects, with higher rates of certain hereditary blood disorders and three categories of metabolic disorders. These estimates are important for planning preconception and antenatal health care, genetic counseling, and clinical care for Arab Americans.

Researching in the community: the value and contribution of nurses to community based or primary health care research.

Science.gov (United States)

Barthow, Christine; Jones, Bernadette; Macdonald, Lindsay; Vernall, Sue; Gallagher, Peter; McKinlay, Eileen

2015-05-01

To describe the role, contribution and value of research nurses in New Zealand community-based or primary health care research. Research nurses are increasingly recognised as having a key role in undertaking successful research in hospitals and clinical trial units however only limited work has been undertaken to examine their role in community-based research. Undertaking health research in the community has unique challenges particularly in relation to research design and recruitment and retention of participants. We describe four community-based research projects involving research nurses, each with particular recruitment, retention and logistical problems. Vignettes are used to illustrate the role, contribution and value of research nurses in a diverse range of community research projects. The knowledge and skills used by research nurses in these projects included familiarity with communities, cultural competence, health care systems and practice philosophies and in particular with vulnerable populations. Their research actions and activities include competence with a broad range of research methodologies, organisational efficiency, family-centred approach, along with advocacy and flexibility. These are underpinned by nursing knowledge and clinical expertise contributing to an ability to work autonomously. These four projects demonstrate that research nurses in community-based research possess specific attributes which facilitate successful study development, implementation and outcome.

Improving Maternal Healthcare Access and Neonatal Survival through a Birthing Home Model in Rural Haiti

Directory of Open Access Journals (Sweden)

Elizabeth Wickstrom

2007-10-01

Full Text Available High neonatal mortality in Haiti is sustained by limited access to essential maternity services, particularly for Haiti’s rural population. We investigated the feasibility of a rural birthing home model to provide basic prenatal, delivery, and neonatal services for women with uncomplicated pregnancies while simultaneously providing triage and transport of women with pregnancy related complications. The model included consideration of the local context, including women’s perceptions of barriers to healthcare access and available resources to implement change. Evaluation methods included the performance of a baseline community census and collection of pregnancy histories from 791 women living in a defined area of rural Haiti. These retrospective data were compared with pregnancy outcome for 668 women subsequently receiving services at the birthing home. Of 764 reported most recent pregnancies in the baseline survey, 663(87% occurred at home with no assistance from skilled health staff. Of 668 women followed after opening of the birthing home, 514 (77% subsequently gave birth at the birthing home, 94 (14% were referred to a regional hospital for delivery, and only 60 (9% delivered at home or on the way to the birthing home. Other measures of clinical volume and patient satisfaction also indicated positive changes in health care seeking. After introduction of the birthing home, fewer neonates died than predicted by historical information or national statistics. The present experience points out the feasibility of a rural birthing home model to increase access to essential maternity services.

Community gardens: lessons learned from California Healthy Cities and Communities.

Science.gov (United States)

Twiss, Joan; Dickinson, Joy; Duma, Shirley; Kleinman, Tanya; Paulsen, Heather; Rilveria, Liz

2003-09-01

Community gardens enhance nutrition and physical activity and promote the role of public health in improving quality of life. Opportunities to organize around other issues and build social capital also emerge through community gardens. California Healthy Cities and Communities (CHCC) promotes an inclusionary and systems approach to improving community health. CHCC has funded community-based nutrition and physical activity programs in several cities. Successful community gardens were developed by many cities incorporating local leadership and resources, volunteers and community partners, and skills-building opportunities for participants. Through community garden initiatives, cities have enacted policies for interim land and complimentary water use, improved access to produce, elevated public consciousness about public health, created culturally appropriate educational and training materials, and strengthened community building skills.

Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports.

Science.gov (United States)

Petrovska, Karolina; Sheehan, Athena; Homer, Caroline S E

2017-07-01

Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth. © 2017 by the American College of Nurse-Midwives.

Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial.

Science.gov (United States)

Kirby, R Lee; Mitchell, Doug; Sabharwal, Sunil; McCranie, Mark; Nelson, Audrey L

2016-01-01

To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group. We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30-45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores. Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.

A rural, community-based suicide awareness and intervention program.

Science.gov (United States)

Jones, Sharon; Walker, Coralanne; Miles, Alison C J; De Silva, Eve; Zimitat, Craig

2015-01-01

Suicide is a prominent public health issue in rural Australia and specifically in Tasmania, which has one of the highest suicide rates in the country. The Community Response to Eliminating Suicide (CORES) program was developed in rural Tasmania in response to a significant number of suicides over a short period of time. CORES is unique in that it is both a community-based and gatekeeper education model. CORES aims to build and empower communities to take ownership of suicide prevention strategies. It also aims to increase the individual community member's interpersonal skills and awareness of suicide risks, while building peer support and awareness of suicide prevention support services within the community itself. Pre- and post-test surveys after the CORES 1-day suicide awareness and intervention program (SAIP) showed significant increases in levels of comfort and confidence in discussing suicide with those who may be contemplating that action. CORES builds community capital through establishing new connections within communities. Establishment of local executive groups, funding and SAIP are key activities of successful CORES programs in communities around Australia. Over half of the initial leaders are still actively involved after a decade, which reflects positively on the quality and outcomes of the program. This study supports CORES as a beneficial and feasible community-based suicide intervention program for rural communities.

Undergraduate nursing students' perceptions of service-learning through a school-based community project.

Science.gov (United States)

Bassi, Sherry

2011-01-01

Service-learning (SL) is an experiential teaching method that combines instruction with community service, with the aim of enriching students' academic learning, interpersonal skills and sense of responsibility while making meaningful contributions to the community. However, measuring outcomes of service-learning projects is difficult. This article reports on the perceptions of 18 third-year undergraduate nursing students who took part in a pilot service-learning project targeting tobacco use in a local elementary school. Faculty members evaluated the program's outcomes by engaging students in structured reflection on the program about its relevance to their future careers as practicing professionals, especially in community-based settings. The students' perceptions were elicited through three sets of reflective assignments following the project. Findings from the reflective assignments suggest that the pilot program was successful in enhancing the students' academic, social, and personal development while building a partnership between the school of nursing and key players in the community, including school-based nurses, teachers, administrators, families, and community leaders. The author suggests that service-learning projects can help nursing students accomplish key developmental tasks of the college years (such as building their competence, autonomy, and integrity), while helping impart the skills and values they will need as they graduate and seek professional nursing roles.

The Relationship between Campus Climate and the Teaching of Critical Thinking Skills in Community College Classrooms

Science.gov (United States)

Simon, Thomas C.

2010-01-01

Although critical thinking skills are important for all citizens participating in a democratic society, many community college students appear to lack these skills. This study addressed the apparent lack of research relating critical thinking instruction to campus climate. Critical thinking theory and Moos's organizational climate theory served as…

Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial.

Directory of Open Access Journals (Sweden)

R Lee Kirby

Full Text Available To test the hypotheses that community-dwelling veterans with spinal cord injury (SCI who receive the Wheelchair Skills Training Program (WSTP in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC group.We carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30-45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST and Craig Handicap Assessment and Reporting Technique (CHART scores.Participants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001 and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021.Individualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.

Acid-base changes in canine neonates following normal birth or dystocia.

Science.gov (United States)

Lúcio, C F; Silva, L C G; Rodrigues, J A; Veiga, G A L; Vannucchi, C I

2009-07-01

There are limited data concerning blood gas parameters in neonatal dogs. Knowledge of the normal physiology may facilitate effective therapeutic intervention and potentially reduce neonatal mortality. This study examined acid-base parameters in pups born at normal parturition (n = 27) compared with those born after obstetrical assistance or caesarean operation (n = 13) and those born following oxytocin (OXY) administration for treatment of uterine inertia (n = 11). Pups were subjected to an objective scoring method of neonatal health adapted from use in humans (the Apgar score) at birth and again at 5 and 60 min after birth. Venous blood samples were collected at 5 and 60 min after birth for evaluation of blood gas parameters. At birth, all pups had low Apgar scores and a mixed acidosis. The base excess was lowest for pups delivered after OXY administration. The Apgar score improved for all pups after 5 min of birth and there was an improvement in carbon dioxide tension, base excess and venous blood pH at 1 h, although in all pups a metabolic acidosis persisted. These data provide an important insight into neonatal physiology and the variability of blood gas parameters in pups born at normal and abnormal parturition and provide the basis for clinical decision making following dystocia.

Developmental Trajectories of Early Communication Skills

Science.gov (United States)

Maatta, Sira; Laakso, Marja-Leena; Tolvanen, Asko; Ahonen, Timo; Aro, Tuija

2012-01-01

Purpose: This study focused on developmental trajectories of prelinguistic communication skills and their connections to later parent-reported language difficulties. Method: The participants represent a subset of a community-based sample of 508 children. Data include parent reports of prelinguistic communication skills at 12, 15, 18, and 21 months…

Tracking progress towards equitable child survival in a Nicaraguan community: neonatal mortality challenges to meet the MDG 4

Directory of Open Access Journals (Sweden)

Persson Lars-Åke

2011-06-01

Full Text Available Abstract Background Nicaragua has made progress in the reduction of the under-five mortality since 1980s. Data for the national trends indicate that this poor Central American country is on track to reach the Millennium Development Goal-4 by 2015. Despite this progress, neonatal mortality has not showed same progress. The aim of this study is to analyse trends and social differentials in neonatal and under-five mortality in a Nicaraguan community from 1970 to 2005. Methods Two linked community-based reproductive surveys in 1993 and 2002 followed by a health and demographic surveillance system providing information on all births and child deaths in urban and rural areas of León municipality, Nicaragua. A total of 49 972 live births were registered. Results A rapid reduction in under-five mortality was observed during the late 1970s (from 103 deaths/1000 live births and the 1980s, followed by a gradual decline to the level of 23 deaths/1000 live births in 2005. This community is on track for the Millennium Development Goal 4 for improved child survival. However, neonatal mortality increased lately in spite of a good coverage of skilled assistance at delivery. After some years in the 1990s with a very small gap in neonatal survival between children of mothers of different educational levels this divide is increasing. Conclusions After the reduction of high under-five mortality that coincided with improved equity in survival in this Nicaraguan community, the current challenge is the neonatal mortality where questions of an equitable perinatal care of good quality must be addressed.

How Effective Are Community College Remedial Math Courses for Students with the Lowest Math Skills?

Science.gov (United States)

Xu, Di; Dadgar, Mina

2018-01-01

Objective: This article examines the effectiveness of remediation for community college students who are identified as having the lowest skills in math. Method: We use transcript data from a state community college system and take advantage of a regression discontinuity design that compares statistically identical students who are assigned to the…

Community-level and individual-level influences of intimate partner violence on birth spacing in sub-Saharan Africa.

Science.gov (United States)

Hung, Kristin J; Scott, Jennifer; Ricciotti, Hope A; Johnson, Timothy R; Tsai, Alexander C

2012-05-01

To estimate the extent to which intimate partner violence (IPV), at the levels of the individual and the community, is associated with shortened interbirth intervals among women in sub-Saharan Africa. We analyzed demographic and health survey data from 11 countries in sub-Saharan Africa. Only multiparous women were included in the analysis. Interbirth interval was the primary outcome. Personal history of IPV was measured using a modified Conflict Tactics Scale. Community prevalence of IPV was measured as the proportion of women in each village reporting a personal history of IPV. We used multilevel modeling to account for the hierarchical structure of the data, allowing us to partition the variation in birth intervals to the four different levels (births, individuals, villages, and countries). Among the 46,697 women in the sample, 11,730 (25.1%) reported a personal history of physical violence and 4,935 (10.6%) reported a personal history of sexual violence. In the multivariable regression model, interbirth intervals were inversely associated with personal history of physical violence (regression coefficient b=-0.60, 95% confidence interval -0.91 to -0.28) and the community prevalence of physical violence (b=-1.41, 95% confidence interval -2.41 to -0.40). Estimated associations with sexual violence were of similar statistical significance and magnitude. Both personal history of IPV and the community prevalence of IPV have independent and statistically significant associations with shorter interbirth intervals. II.

Vaginal breech birth: can we move beyond the Term Breech Trial?

Science.gov (United States)

Hunter, Linda A

2014-01-01

Since the publication of the Term Breech Trial in 2000, planned cesarean has become the preferred mode of birth for women whose fetus is in a breech presentation. Over the past 20 years, however, subsequent evidence has not shown conclusively that cesarean birth is safer than vaginal birth for a fetus in a breech presentation when certain criteria are met. Many obstetric organizations support the option of planned vaginal birth for women with a breech presentation under strict prelabor selection criteria and intrapartum management guidelines. The growing trend toward cesarean unfortunately has left midwives and other intrapartum care providers in training with dwindling opportunities to competently master skills for vaginal breech birth. Although simulation training offers opportunities to practice infrequently encountered skills such as vaginal breech birth, it is unknown if this alternative will provide sufficient experience for future generations of clinicians. As a result, women with a breech presentation at term who desire a trial of labor often have limited choices. This article reviews the controversies surrounding the ideal mode of birth created by the Term Breech Trial. Criteria for vaginal breech birth are summarized and the role of simulation explored. Implications for midwifery practice when a breech presentation is diagnosed are also included. © 2014 by the American College of Nurse-Midwives.

Does the impact of a plant-based diet during pregnancy on birth weight differ by ethnicity? A dietary pattern analysis from a prospective Canadian birth cohort alliance.

Science.gov (United States)

Zulyniak, Michael A; de Souza, Russell J; Shaikh, Mateen; Desai, Dipika; Lefebvre, Diana L; Gupta, Milan; Wilson, Julie; Wahi, Gita; Subbarao, Padmaja; Becker, Allan B; Mandhane, Piush; Turvey, Stuart E; Beyene, Joseph; Atkinson, Stephanie; Morrison, Katherine M; McDonald, Sarah; Teo, Koon K; Sears, Malcolm R; Anand, Sonia S

2017-11-14

Birth weight is an indicator of newborn health and a strong predictor of health outcomes in later life. Significant variation in diet during pregnancy between ethnic groups in high-income countries provides an ideal opportunity to investigate the influence of maternal diet on birth weight. Four multiethnic birth cohorts based in Canada (the NutriGen Alliance). 3997 full-term mother-infant pairs of diverse ethnic groups who had principal component analysis-derived diet pattern scores-plant-based, Western and health-conscious-and birth weight data. No associations were identified between the Western and health-conscious diet patterns and birth weight; however, the plant-based dietary pattern was inversely associated with birth weight (β=-67.6 g per 1-unit increase; P<0.001), and an interaction with non-white ethnicity and birth weight was observed. Ethnically stratified analyses demonstrated that among white Europeans, maternal consumption of a plant-based diet associated with lower birth weight (β=-65.9 g per 1-unit increase; P<0.001), increased risk of small-for-gestational age (SGA; OR=1.46; 95% CI 1.08 to 1.54;P=0.005) and reduced risk of large-for-gestational age (LGA; OR=0.71; 95% CI 0.53 to 0.95;P=0.02). Among South Asians, maternal consumption of a plant-based diet associated with a higher birth weight (β=+40.5 g per 1-unit increase; P=0.01), partially explained by cooked vegetable consumption. Maternal consumption of a plant-based diet during pregnancy is associated with birth weight. Among white Europeans, a plant-based diet is associated with lower birth weight, reduced odds of an infant born LGA and increased odds of SGA, whereas among South Asians living in Canada, a plant-based diet is associated with increased birth weight. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Childbirth in a rural highlands community in Papua New Guinea: a descriptive study.

Science.gov (United States)

Vallely, Lisa M; Homiehombo, Primrose; Kelly-Hanku, Angela; Vallely, Andrew; Homer, Caroline S E; Whittaker, Andrea

2015-03-01

to explore men's and women's experiences, beliefs and practices surrounding childbirth in a rural highlands community in Papua New Guinea. a qualitative study comprising focus group discussions, key informant and in depth interviews. the study was undertaken in a rural community in Eastern Highlands Province, Papua New Guinea. 51 women and 26 men participated in 11 focus group discussions. Key informant and in depth interviews were undertaken with 21 women and five men. both women and men recognised the importance of health facility births, linking village births with maternal and newborn deaths. Despite this, many women chose to give birth in the community in circumstances influenced by cultural and customary beliefs and practices. Women giving birth in the community frequently gave birth in an isolated location. Traditional beliefs surrounding reasons for difficult births, including spiritual beliefs were reported along with the use of traditional methods used to help prolonged and difficult births. while the importance of health facility births is recognised in this rural community many women continue to give birth in the village. Identifying and understanding local customs, beliefs and practices, particularly those that may be harmful to women and their newborn infants, is critical to the development of locally-appropriate community-based strategies for improving maternal and infant health in rural communities in PNG and other resource-limited, high burden settings. Copyright © 2014 Elsevier Ltd. All rights reserved.

Community Bioethics: The Health Decisions Community Council.

Science.gov (United States)

Gallegos, Tom; Mrgudic, Kate

1993-01-01

Sees health care decision making posing variety of complex issues for individuals, families, and providers. Describes Health Decisions Community Council (HDCC), community-based bioethics committee established to offer noninstitutional forum for discussion of health care dilemmas. Notes that social work skills and values for autonomy and…

Bacterial communities found in placental tissues are associated with severe chorioamnionitis and adverse birth outcomes.

Directory of Open Access Journals (Sweden)

Ronan M Doyle

Full Text Available Preterm birth is a major cause of neonatal mortality and morbidity worldwide. Bacterial infection and the subsequent inflammatory response are recognised as an important cause of preterm birth. It is hypothesised that these organisms ascend the cervical canal, colonise placental tissues, cause chorioamnionitis and in severe cases infect amniotic fluid and the foetus. However, the presence of bacteria within the intrauterine cavity does not always precede chorioamnionitis or preterm birth. Whereas previous studies observing the types of bacteria present have been limited in size and the specificity of a few predetermined organisms, in this study we characterised bacteria found in placental tissues from a cohort of 1391 women in rural Malawi using 16S ribosomal RNA gene sequencing. We found that specific bacteria found concurrently on placental tissues associate with chorioamnionitis and delivery of a smaller newborn. Severe chorioamnionitis was associated with a distinct difference in community members, a higher bacterial load and lower species richness. Furthermore, Sneathia sanguinengens and Peptostreptococcus anaerobius found in both matched participant vaginal and placental samples were associated with a lower newborn length-for-age Z-score. This is the largest study to date to examine the placental microbiome and its impact of birth outcomes. Our results provide data on the role of the vaginal microbiome as a source of placental infection as well as the possibility of therapeutic interventions against targeted organisms during pregnancy.

Community-Based Research (CBR in the Education Doctorate: Lessons Learned and Promising Practices

Directory of Open Access Journals (Sweden)

Laurie Stevahn

2016-12-01

Full Text Available Community-based research (CBR is an advanced form of academic service-learning through which university students, faculty, and community organizations collaborate to conduct inquiry projects aimed at producing social change. Despite its potential for advancing learning in graduate studies, little research exists on CBR implementations or outcomes in doctoral programs. This study examined the effectiveness of integrating CBR into an educational leadership doctorate across three consecutive cohorts in which students worked in teams to conduct CBR projects, each in partnership with a community organization pursuing a social justice initiative. A mixed-methods developmental case study design produced quantitative and qualitative data on students’ perceived effectiveness of cooperative/collaborative interaction and team decision making in CBR, experience with and learning from CBR in the education doctorate, and development of CBR competencies. Triangulated results overall revealed students’ (a positive attitudes toward CBR, (b enhanced understanding of and commitment to CBR and how to conduct it, (c expanded understanding and application of technical research skills, (d growth in coopera-tive/collaborative and conflict resolution skills, and (e development of leadership project management skills. These findings may assist faculty in planning innovative, authentic, applied, professional training in the education doctorate capable of advancing students’ graduate inquiry skills while also enhancing competencies for successful leadership in the field.

Perceptions of community-based field workers on the effect of a longitudinal biomedical research project on their sustainable livelihoods

Directory of Open Access Journals (Sweden)

Christabelle S. Moyo

2017-03-01

Full Text Available Abstract Background Researchers involved in biomedical community-based projects rarely seek the perspectives of community fieldworkers, who are the ‘foot soldiers’ in such projects. Understanding the effect of biomedical research on community-based field workers could identify benefits and shortfalls that may be crucial to the success of community-based studies. The present study explored the perceptions of community-based field workers on the effect of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project" (MAL-ED South Africa on their tangible and intangible capital which together comprise sustainable livelihoods. Methods The study was conducted in Dzimauli community in Limpopo Province of South Africa between January-February 2016. The sustainable livelihoods framework was used to query community-based field workers’ perspectives of both tangible assets such as income and physical assets and intangible assets such as social capital, confidence, and skills. Data were collected through twenty one individual in-depth interviews and one focus group discussion. Data were analysed using the Thematic Content Analysis approach supported by ATLAS.ti, version 7.5.10 software. Results All the field workers indicated that they benefitted from the MAL-ED South Africa project. The benefits included intangible assets such as acquisition of knowledge and skills, stronger social capital and personal development. Additionally, all indicated that MAL-ED South Africa provided them with the tangible assets of increased income and physical assets. Observations obtained from the focus group discussion and the community-based leaders concurred with the findings from the in-depth interviews. Additionally, some field workers expressed the desire for training in public relations, communication, problem solving and confidence building. Conclusions The MAL-ED South Africa

Factors associated with utilization of skilled service delivery among women in rural Northern Ghana: a cross sectional study.

Science.gov (United States)

Gudu, William; Addo, Bright

2017-05-31

Ghana's current Maternal Mortality Ratio (MMR) of 319 per 100,000 live births makes achievement of the Sustainable Development Goal of 70 maternal deaths per 100,000 live births or less by 2030 appear to be illusory. Skilled assistance during childbirth is a critical strategy to reducing maternal mortality, yet the proportion of deliveries taking place within health facilities where such assistance is provided is very low in Ghana, with huge disparity between urban and rural women. To address the gap in skilled attendance in rural Upper East Region, the Ghana Health Service (GHS) in 2005 piloted a program that involved training of Community Health Officers (CHOs) as midwives. This study explored factors associated with skilled delivery services utilization in a predominantly rural district in Ghana. A cross-sectional study, data was collected from a sample of 400 women between the ages of 15 and 49 years who had given birth a year prior to the study. We used frequencies and percentages for descriptive analysis and chi-square (χ 2 ) test for relationship between independents factors and utilization of skilled delivery services. Of the 400 women included in the analysis, 93.3% of them delivered in a health facility. Almost all of the mothers (97.3%) attended or received antenatal care at their last pregnancy with 75.0% of them having four or more ANC visits. The proportion of women who received ANC and utilized skilled delivery services was high (91.5%). Mother's educational attainment, ANC attendance, frequency of ANC visits, satisfaction with ANC services and possession of valid NHIS card significantly associated with utilisation of skilled delivery services. For a predominantly rural district, the percentage of women who deliver within health facilities where skilled assistance is available is very encouraging and a significant stride towards reducing Ghana's overall MMR. Having four or more ANC visits and improving on the quality of care provided has a great

Selecting pilots with crew resource management skills.

Science.gov (United States)

Hedge, J W; Bruskiewicz, K T; Borman, W C; Hanson, M A; Logan, K K; Siem, F M

2000-10-01

For years, pilot selection has focused primarily on the identification of individuals with superior flying skills and abilities. More recently, the aviation community has become increasingly aware that successful completion of a flight or mission requires not only flying skills but the ability to work well in a crew situation. This project involved development and validation of a crew resource management (CRM) skills test for Air Force transport pilots. A significant relation was found between the CRM skills test and behavior-based ratings of aircraft commander CRM performance, and the implications of these findings for CRM-based selection and training are discussed.

Teaching nutrition to medical students: a community-based problem-solving approach.

Science.gov (United States)

Bhattacharji, S; Joseph, A; Abraham, S; Muliyil, J; John, K R; Ethirajan, N

1990-01-01

This paper presents a community-based problem-solving educational programme which aims at teaching medical and other health science students the importance of nutrition and its application. Through community surveys students assess the nutritional status of children under five using different anthropometric methods. They understand the cultural beliefs and customs related to food fads and the reasons for them. They also acquire the skill to educate the community using the information gathered. They use epidemiological methods such as case control study to find associations between malnutrition and other causative factors. Feedback from students has been positive and evaluation of students' knowledge before and after the programme has shown significant improvement.

Improving Climate Change Communication Skills through Community Outreach

Science.gov (United States)

Hanrahan, J.

2015-12-01

While many undergraduate Atmospheric Science departments are expanding their curriculums to focus on the science of climate change, often overlooked is the need to educate students about how this topic can be effectively communicated to others. It has become increasingly difficult for young scientists to comfortably discuss this polarizing topic with people outside of the classroom. To address this, Atmospheric Science faculty at Lyndon State College are providing undergraduate students the opportunity to practice this important skill by reaching out to the local community. Over the past year, students have been meeting regularly to discuss climate change and its impacts, and to present this information to the general public at local schools and organizations. The group was organized with the primary goal of teaching undergraduate students about effective ways to communicate basic climate science to nonscientists, but to also improve public understanding of anthropogenic climate change while starting a conversation among young people in the community. We will identify lessons learned after one year, discuss effective strategies, and summarize student feedback.

Community College Program Planning: A Method to Measure and Meet Community Need

Science.gov (United States)

Perez-Vergara, Kelly; Lathrop, Rachel; Orlowski, Martin

2018-01-01

Offering academic programs that meet community need has long been a core mission of community colleges. However, determining which job skills and credentials are needed for employment in the community is challenging. In order to facilitate a holistic and community-based perspective, our 2-year community college developed a structured curricular…

Assessment of Mindfulness with the French Version of the Kentucky Inventory of Mindfulness Skills in Community and Borderline Personality Disorder Samples

Science.gov (United States)

Nicastro, Rosetta; Jermann, Francoise; Bondolfi, Guido; McQuillan, Annabel

2010-01-01

This article explores mindfulness skills in community and borderline personality disorder (BPD) samples. Study 1 includes 173 community volunteers and explores the psychometric properties of the French version of the Kentucky Inventory of Mindfulness Skills (KIMS). Study 2 explores the KIMS factor structure in 130 BPD patients and compares KIMS…

Community Based Nutrition Rehabilitation in Tanzania: Challenges and Lessons Learned

International Nuclear Information System (INIS)

Urio, Elisaphinate Moses; Jeje, Benedict; Ndossi, Godwin

2014-01-01

Full text: Malnutrition among children under the age of five continues to be a significant public health problem in Tanzania. Despite numerous nutritional interventions that have been implemented, the country still experiences high rates of malnutrition. According to Tanzania Demographic and Health Survey of 2010 the prevalence of underweight was estimated to be 16%, wasting 5% and stunting 42 %. Factors contributing to causes of malnutrition include immediate, underlying and basic causes. All these factors are interlinked and operate synergistically and not independently. Approaches for managing malnourished children in Tanzania evolved from facility based Nutrition Rehabilitation Units (NURU) in the late 1960s to Community Based Nutrition Rehabilitation (CBNR) in late 1980s. In the latter approach, malnourished children are rehabilitated in the same environment (village, home) that precipitated the condition, using resources and infrastructures available in the community. Mothers are taught about child feeding using family foods to make good food mixtures and of the importance of feeding frequency for the young child. Limitations for this approach include inadequate advocacy to leaders from districts down to the community level, few trained health providers and community health workers on knowledge and skills on community based nutrition rehabilitation, inadequate equipment and supplies for identification and categorization of malnutrition, low awareness of parents, care givers and community leaders on home rehabilitation of malnourished children. Nonetheless, Community Based Nutrition Rehabilitation approach has the potential to address malnutrition in children given political will and resources. (author)

Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: a mixed-methods study.

Science.gov (United States)

Brooks, Mohamad I; Thabrany, Hasbullah; Fox, Matthew P; Wirtz, Veronika J; Feeley, Frank G; Sabin, Lora L

2017-02-02

The growing momentum for quality and affordable health care for all has given rise to the recent global universal health coverage (UHC) movement. As part of Indonesia's strategy to achieve the goal of UHC, large investments have been made to increase health access for the poor, resulting in the implementation of various health insurance schemes targeted towards the poor and near-poor, including the Jamkesmas program. In the backdrop of Indonesia's aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects poor women. The objective of this study was to evaluate the association of health facility and skilled birth deliveries among poor women with and without Jamkesmas and explore perceived barriers to health insurance membership and maternal health service utilization. We used a mixed-methods design. Utilizing data from the 2012 Indonesian Demographic and Health Survey (n = 45,607), secondary analysis using propensity score matching was performed on key outcomes of interest: health facility delivery (HFD) and skilled birth delivery (SBD). In-depth interviews (n = 51) were conducted in the provinces of Jakarta and Banten among poor women, midwives, and government representatives. Thematic framework analysis was performed on qualitative data to explore perceived barriers. In 2012, 63.0% of women did not have health insurance; 19.1% had Jamkesmas. Poor women with Jamkesmas were 19% (OR = 1.19 [1.03-1.37]) more likely to have HFD and 17% (OR = 1.17 [1.01-1.35]) more likely to have SBD compared to poor women without insurance. Qualitative interviews highlighted key issues, including: lack of proper documentation for health insurance registration; the preference of pregnant women to deliver in their parents' village; the use of traditional birth attendants; distance to health facilities; shortage of qualified health providers; overcrowded health facilities; and lack of health facility accreditation. Poor women with

Phronesis: Beyond the Research Ethics Committee-A Crucial Decision-Making Skill for Health Researchers During Community Research.

Science.gov (United States)

Greeff, Minrie; Rennie, Stuart

2016-04-01

Health researchers conducting research in the community are often faced with unanticipated ethical issues that arise in the course of their research and that go beyond the scope of ethical approval by the research ethics committee. Eight expert researchers were selected through extreme intensity purposive sampling, because they are representative of unusual manifestations of the phenomenon related to their research in the community. They were selected to take part in a semi-structured focus group discussion on whether practical wisdom (phronesis) is used as a decision-making skill to solve unanticipated ethical issues during research in the community. Although the researchers were not familiar with the concept phronesis, it became obvious that it formed an integral part of their everyday existence and decision making during intervention research. They could balance research ethics with practical considerations. The capacity of practical wisdom as a crucial decision-making skill should be assimilated into a researcher's everyday reality, and also into the process of mentoring young researchers to become phronimos. Researchers should be taught this skill to handle unanticipated ethical issues. © The Author(s) 2016.

Hypnotherapy for labor and birth.

Science.gov (United States)

Beebe, Kathleen R

2014-01-01

Hypnotherapy is an integrative mind-body technique with therapeutic potential in various health care applications, including labor and birth. Evaluating the efficacy of this modality in controlled studies can be difficult, because of methodologic challenges, such as obtaining adequate sample sizes and standardizing experimental conditions. Women using hypnosis techniques for childbirth in hospital settings may face barriers related to caregiver resistance or institutional policies. The potential anxiolytic and analgesic effects of clinical hypnosis for childbirth merit further study. Nurses caring for women during labor and birth can increase their knowledge and skills with strategies for supporting hypnotherapeutic techniques. © 2014 AWHONN.

Magnitude and factors associated with institutional delivery service utilization among childbearing mothers in Cheha district, Gurage zone, SNNPR, Ethiopia: a community based cross sectional study.

Science.gov (United States)

Habte, Feleke; Demissie, Meaza

2015-11-17

Ethiopia is one of the six countries that contributes' to more than 50 % of worldwide maternal deaths. While it is revealed that delivery attended by skilled provider at health facility reduced maternal deaths, more than half of all births in Ethiopia takes place at home. According to EDHS 2011 report nine women in every ten deliver at home in Ethiopia. The situation is much worse in southern region. The aim of our study is to measure the prevalence and to identify factors associated with institutional delivery service utilization among childbearing mothers in Cheha District, SNNPR, Ethiopia. A community based cross sectional survey was conducted in Cheha District from Dec 22, 2012 to Jan 11, 2013. Multistage sampling method was employed and 816 women who gave birth within the past 2 years and lived in Cheha district for minimum of one year prior to the survey were involved in the study. Data was entered and analyzed using Epi Info Version 7 and SPSS Version 16. Frequencies and binary logistic regression were done. Factors affecting institutional delivery were determined using multivariate logistic regression. A total of 31 % of women gave birth to their last child at health facility. Place of residence, ability to afford for the whole process to get delivery service at health facility, traveling time that takes to reach to health institution which provides delivery service, husband's attitude towards institutional delivery, counseling about where to deliver during ANC visit and place of birth of the 2(nd) youngest child were found to have statistically significant association with institutional delivery. Institutional delivery is low in the study area. Access to health service was found to be the most important predictor of institutional delivery among others. Accessing health facility within reasonable travel time; providing health education and BCC services to husbands and the community at large on importance of using health institution for delivery service

Temporal trends in Inuit, First Nations and non-Aboriginal birth outcomes in rural and northern Quebec.

Science.gov (United States)

Simonet, Fabienne; Wilkins, Russell; Luo, Zhong-Cheng

2012-01-01

The objective was to assess trends in Inuit, First Nations and non-Aboriginal birth outcomes in the rural and northern regions of Quebec. In a birth cohort-based study of all births to residents of rural and northern Quebec from 1991 through 2000 (n = 177,193), we analyzed birth outcomes and infant mortality for births classified by maternal mother tongue (Inuit, First Nations or non-Aboriginal) and by community type (predominantly First Nations, Inuit or non-Aboriginal). From 1991-1995 to 1996-2000, there was a trend of increasing rates of preterm birth for all 6 study groups. In all rural and northern areas, low birth weight rates increased significantly only for the Inuit mother tongue group [RR1.45 (95% CI 1.05-2.01)]. Stillbirth rates showed a non-significant increase for the Inuit mother tongue group [RR1.76 (0.64-4.83)]. Neonatal mortality rates decreased significantly in the predominantly non-Aboriginal communities and in the non-Aboriginal mother tongue group [RR0.78 (0.66-0.92)], and increased non-significantly for the First Nations mother tongue group [RR2.17 (0.71-6.62)]. Perinatal death rates increased for the First Nations mother tongue grouping in northern areas [RR2.19 (0.99-4.85)]. There was a disconcerting rise of some mortality outcomes for births to First Nations and Inuit mother tongue women and to women in predominantly First Nations and Inuit communities, in contrast to some improvements for births to non-Aboriginal mother tongue women and to women in predominantly non-Aboriginal communities in rural or northern Quebec, indicating a need for improving perinatal and neonatal health for Aboriginal populations in rural and northern regions.

Temporal trends in Inuit, First Nations and non-Aboriginal birth outcomes in rural and northern Quebec

Directory of Open Access Journals (Sweden)

Fabienne Simonet

2012-06-01

Full Text Available Objectives. The objective was to assess trends in Inuit, First Nations and non-Aboriginal birth outcomes in the rural and northern regions of Quebec. Study design and methods. In a birth cohort-based study of all births to residents of rural and northern Quebec from 1991 through 2000 (n = 177,193, we analyzed birth outcomes and infant mortality for births classified by maternal mother tongue (Inuit, First Nations or non-Aboriginal and by community type (predominantly First Nations, Inuit or non-Aboriginal. Results. From 1991–1995 to 1996–2000, there was a trend of increasing rates of preterm birth for all 6 study groups. In all rural and northern areas, low birth weight rates increased significantly only for the Inuit mother tongue group [RR1.45 (95% CI 1.05–2.01]. Stillbirth rates showed a non-significant increase for the Inuit mother tongue group [RR1.76 (0.64–4.83]. Neonatal mortality rates decreased significantly in the predominantly non-Aboriginal communities and in the non-Aboriginal mother tongue group [RR0.78 (0.66–0.92], and increased non-significantly for the First Nations mother tongue group [RR2.17 (0.71–6.62]. Perinatal death rates increased for the First Nations mother tongue grouping in northern areas [RR2.19 (0.99–4.85]. Conclusion. There was a disconcerting rise of some mortality outcomes for births to First Nations and Inuit mother tongue women and to women in predominantly First Nations and Inuit communities, in contrast to some improvements for births to non-Aboriginal mother tongue women and to women in predominantly non-Aboriginal communities in rural or northern Quebec, indicating a need for improving perinatal and neonatal health for Aboriginal populations in rural and northern regions.

Promoting a skills-based agenda in Olympic sports: the role of skill-acquisition specialists.

Science.gov (United States)

Williams, A Mark; Ford, Paul R

2009-11-01

We highlight the importance of promoting a skills-based agenda in the development and preparation of Olympic athletes. The role that specialists with a background in skill acquisition can play is illustrated and the need to move towards a culture where evidence-based practice permeates all aspects of this process reiterated. We provide examples from contemporary research to illustrate how skill-acquisition theory and practice can help inform and guide practitioners, coaches, and administrators in their quest to develop Olympic athletes. Although the acquisition and refinement of skills are essential to performance in most Olympic sports, paradoxically the area of skill acquisition has not impacted in a concerted and meaningful way on this agenda. Skill-acquisition specialists need to be more proactive in forging links with elite sport, whereas practitioners, coaches, and administrators need to appreciate the important role that sports scientists with a background in this area can play in helping to develop future generations of podium athletes.

Teaching Soft Skills Employers Need

Science.gov (United States)

Ellis, Maureen; Kisling, Eric; Hackworth, Robbie G.

2014-01-01

This study identifies the soft skills community colleges teach in an office technology course and determines whether the skills taught are congruent with the soft skills employers require in today's entry-level office work. A qualitative content analysis of a community college office technology soft skills course was performed using 23 soft skills…

Effect of maternal age on facility-based delivery: analysis of first-order births in 34 countries of sub-Saharan Africa using demographic and health survey data.

Science.gov (United States)

Dunlop, Catherine L; Benova, Lenka; Campbell, Oona

2018-04-13

Increasing access to skilled birth attendance, usually via childbirth in health facilities, is a key intervention to reduce maternal and perinatal mortality and morbidity. Yet, in some countries of sub-Saharan Africa, the uptake is Health Surveys from 34 sub-Saharan African countries were used to assess women's delivery locations. 72 772 women having their first birth in the 5 years preceding the surveys were included in the analysis. Proportions and 95% CIs of facility-based deliveries were estimated overall and by country. Multivariable logistic regression was used to calculate the odds of facility-based delivery for different maternal age groups (15-19, 20-24 and ≥25 years) for a pooled sample of all countries. 59.9% of women had a facility-based delivery for their first birth (95% CI 58.6 to 61.2), ranging from 19.4% in Chad to 96.6% in Rwanda. Compared with women aged 15-19 years, the adjusted odds of having a facility-based delivery for those aged 20-24 was 1.4 (95% CI 1.3 to 1.5, psub-Saharan Africa. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PENINGKATAN SOFT SKILLS DAN HARD SKILLS MAHASISWA MELALUI PROJECT-BASED LEARNING PADA MATA KULIAH PERENCANAAN PEMBELAJARAN GEOGRAFI

Directory of Open Access Journals (Sweden)

Fitra Delita

2016-08-01

Full Text Available Penelitian ini dilakukan karena masih minimnya kemampuan soft skills dan hard skills mahasiswa. Penelitian ini bertujuan untuk meningkatkan soft skills dan hard skills mahasiswa melalui penerapan Project Based Learning pada mata kuliah Perencanaan Pembelajaran Geografi serta untuk mengetahui tanggapan mahasiswa terhadap penerapan Project Based Learning. Penelitian ini tergolong penelitian PTK dengan pengamatan selama 2 siklus. Indikator soft skills yang diamati adalah komunikasi lisan, kejujuran, partisipasi dan kreativitas. Sedangkan indikator hard skills yang digunakan adalah nilai mahasiswa, kemampuan merancang perangkat pembelajaran dan media. Data diperoleh melalui lembar observasi, kuesioner, penilaian product dan hasil tes. Hasil penelitian menunjukkan bahwa terjadi peningkatan indikator soft skill yaitu komunikasi lisan (0,54, partisipasi (0,92, kejujuran (0,42 dan kreativitas (1,4 Peningkatan jumlah mahasiswa yang mendapat nilai A pada Siklus II yaitu 8 orang (naik 25 % dari total mahasiswa, nilai B meningkat menjadi 2 orang (naik 6 % dari total mahasiswa. Indikator hard skills berupa kemampuan merancang perangkat pembelajaran dan media juga mengalami kenaikan pada Siklus II yaitu 21 orang (68 % kategori sangat baik dan 10 orang (32 % kategori baik. Mahasiswa memberi tanggapan positif terhadap penerapan Project Based Learning pada mata kuliah Perencanaan Pembelajaran Geografi. Kata kunci: Soft Skills, Hard Skills, Project Based Learning

Misoprostol for the prevention of postpartum hemorrhage during home births in rural Lao PDR: establishing a pilot program for community distribution.

Science.gov (United States)

Durham, Jo; Phengsavanh, Alongkone; Sychareun, Vanphanom; Hose, Isaac; Vongxay, Viengnakhone; Xaysomphou, Douangphachanh; Rickart, Keith

2018-01-01

The purpose of this study was to gather the necessary data to support the design and implementation of a pilot program for women who are unable to deliver in a healthcare facility in the Lao People's Democratic Republic (PDR), by using community distribution of misoprostol to prevent postpartum hemorrhage (PPH). The study builds on an earlier research that demonstrated both support and need for community-based distribution of misoprostol in Lao PDR. This qualitative study identified acceptability of misoprostol and healthcare system needs at varying levels to effectively distribute misoprostol to women with limited access to facility-based birthing. Interviews (n=25) were undertaken with stakeholders at the central, provincial, and district levels and with community members in five rural communities in Oudomxay, a province with high rates of maternal mortality. Focus group discussions (n=5) were undertaken in each community. Respondents agreed that PPH was the major cause of preventable maternal mortality with community distribution of misoprostol an acceptable and feasible interim preventative solution. Strong leadership, training, and community mobilization were identified as critical success factors. While several participants preferred midwives to distribute misoprostol, given the limited availability of midwives, there was a general agreement that village health workers or other lower level workers could safely administer misoprostol. Many key stakeholders, including women themselves, considered that these community-level staff may be able to provide misoprostol to women for self-administration, as long as appropriate education on its use was included. The collected data also helped identify appropriate educational messages and key indicators for monitoring and evaluation for a pilot program. The findings strengthen the case for a pilot program of community distribution of misoprostol to prevent PPH in remote communities where women have limited access to a

Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda

Directory of Open Access Journals (Sweden)

Joharifard Shahrzad

2012-12-01

Full Text Available Abstract Background The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249–584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda. Methods Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18–50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities. Results Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839], possessing health insurance (OR = 3.812 [1.795 - 8.097], managing household finances (OR = 1.897 [1.046 - 3.439], attending more antenatal care visits (OR = 1.567 [1.163 - 2.112], delivering more recently (OR = 1.438 [1.120 - 1.847] annually, and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km were independently associated with facility delivery. Conclusions The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a

Modification of Obstetric Emergency Simulation Scenarios for Realism in a Home-Birth Setting.

Science.gov (United States)

Komorowski, Janelle; Andrighetti, Tia; Benton, Melissa

2017-01-01

Clinical competency and clear communication are essential for intrapartum care providers who encounter high-stakes, low-frequency emergencies. The challenge for these providers is to maintain infrequently used skills. The challenge is even more significant for midwives who manage births at home and who, due to low practice volume and low-risk clientele, may rarely encounter an emergency. In addition, access to team simulation may be limited for home-birth midwives. This project modified existing validated obstetric simulation scenarios for a home-birth setting. Twelve certified professional midwives (CPMs) in active home-birth practice participated in shoulder dystocia and postpartum hemorrhage simulations. The simulations were staged to resemble home-birth settings, supplies, and personnel. Fidelity (realism) of the simulations was assessed with the Simulation Design Scale, and satisfaction and self-confidence were assessed with the Student Satisfaction and Self-Confidence in Learning Scale. Both utilized a 5-point Likert scale, with higher scores suggesting greater levels of fidelity, participant satisfaction, and self-confidence. Simulation Design Scale scores indicated participants agreed fidelity was achieved for the home-birth setting, while scores on the Student Satisfaction and Self-Confidence in Learning indicated high levels of participant satisfaction and self-confidence. If offered without modification, simulation scenarios designed for use in hospitals may lose fidelity for home-birth midwives, particularly in the environmental and psychological components. Simulation is standard of care in most settings, an excellent vehicle for maintaining skills, and some evidence suggests it results in improved perinatal outcomes. Additional study is needed in this area to support home-birth providers in maintaining skills. This pilot study suggests that simulation scenarios intended for hospital use can be successfully adapted to the home-birth setting. © 2016 by

Neonatal mortality in Missouri home births, 1978-84.

Science.gov (United States)

Schramm, W F; Barnes, D E; Bakewell, J M

1987-08-01

A study was conducted of 4,054 Missouri home births occurring from 1978 through 1984. Of the 3,645 births whose planning status was identified, 3,067 (84 per cent) were planned to be at home. Neonatal mortality was elevated for both planned (17 observed deaths vs 8.59 expected deaths) and unplanned home births (45 observed vs 33.19 expected) compared with physician-attended hospital births. Nearly all of the mortality excess for planned home births occurred in association with lesser trained attendants (12 observed vs 4.42 expected), while for unplanned home births the excess was entirely among infants weighing 1500 grams or more (19 observed vs 3.50 expected). For planned home births attended by physicians, certified nurse-midwives, or Missouri Midwife Association recognized midwives, there was little difference between observed and expected deaths (5 observed vs 3.92 expected). There also was little difference in deaths for unplanned home births weighing less than 1500 grams (26 observed vs 29.69 expected) compared with hospital births. The study provides evidence of the importance of having skilled attendants present at planned home births.

The Effect of an Interdisciplinary Community Health Project on Student Attitudes toward Community Health, People Who Are Indigent and Homeless, and Team Leadership Skill Development.

Science.gov (United States)

Rose, Molly A.; Lyons, Kevin J.; Miller, Kathleen Swenson; Cornman-Levy, Diane

2003-01-01

A study of 22 health occupations students examined whether participation in an interdisciplinary community health empowerment project with urban homeless and formerly homeless people changed their attitudes about community health practice, attitudes toward people who are indigent and homeless, and perceived leadership skills. Posttests revealed a…

Vital Signs – Preventing Repeat Teen Births

Centers for Disease Control (CDC) Podcasts

2013-04-02

This podcast is based on the April 2013 CDC Vital Signs report, which discusses repeat teen births and ways teens, parents and guardians, health care providers, and communities can help prevent them.  Created: 4/2/2013 by Centers for Disease Control and Prevention (CDC).   Date Released: 4/2/2013.

Barriers to hospital births: why do many Bolivian women give birth at home?

Directory of Open Access Journals (Sweden)

Kelsey E. Otis

2008-07-01

Full Text Available OBJECTIVES: This study investigated the low rates of hospital/health center births recorded in Yapacaní, Bolivia, that persist despite the national maternal-infant insurance program designed to ensure equitable access to free center-based health care services for pregnant women. The purpose of this study was to identify the multilevel factors inhibiting access to and utilization of public health centers for labor and delivery. METHODS: Qualitative research methods were used, including participant observation, semistructured interviews of 62 community members, and key informant interviews with eight regional experts. Data were coded and analyzed using the grounded theory approach. RESULTS: From the semistructured interview data, five reasons for the low rate of institutional births and their frequency were identified: (1 fear or embarrassment related to receiving care at a public health care center (37%; (2 poor quality of care available at the health care centers (22%; (3 distance from or other geographic issues preventing timely travel to health care services (21%; (4 economic constraints preventing travel to or utilization of health care services (14%; and (5 the perception that health care services are not necessary due to the experience of "easy birth" (6%. CONCLUSIONS: The reasons for the low rate of births in public health centers exist within the context of deficient resources, politics, and cultural differences that all influence the experience of women and their partners at the time of birth. These large scale, contextual issues must be taken into account to improve access to quality health care services for all Bolivian women at the time of birth. Resources at the national level must be carefully targeted to ensure that governmental services will successfully instill confidence in Bolivian women and facilitate their overcoming the cultural, geographic, economic, and logistical barriers to accessing "free" services.

Teenage births to ethnic minority women.

Science.gov (United States)

Berthoud, R

2001-01-01

This article analyses British age-specific fertility rates by ethnic group, with a special interest in child-bearing by women below the age of 20. Birth statistics are not analysed by ethnic group, and teenage birth rates have been estimated from the dates of birth of mothers and children in the Labour Force Survey. The method appears to be robust. Caribbean, Pakistani and especially Bangladeshi women were much more likely to have been teenage mothers than white women, but Indian women were below the national average. Teenage birth rates have been falling in all three South Asian communities.

Skilled delivery service utilization and its association with the establishment of Women's Health Development Army in Yeky district, South West Ethiopia: a multilevel analysis.

Science.gov (United States)

Negero, Melese Girmaye; Mitike, Yifru Berhan; Worku, Abebaw Gebeyehu; Abota, Tafesse Lamaro

2018-01-30

Because of the unacceptably high maternal and perinatal morbidity and mortality, the government of Ethiopia has established health extension program with a community-based network involving health extension workers (HEWs) and a community level women organization which is known as "Women's Health Development Army" (WHDA). Currently, the HEWs and WHDA network is the approach preferred by the government to register pregnant women and encourage them to link in the healthcare system. However, its association with skilled delivery service utilization is not well known. A community-based cross-sectional study was conducted from January to February 2015. Within 380 clusters of WHDA, a total of 748 reproductive-age women who gave birth in 1 year preceding the study, were included using multistage sampling technique. The data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Multilevel analysis technique was applied to check for an association of selected variables with a utilization of skilled delivery service. About 45% of women have received skilled delivery care. A significant heterogeneity was observed between "Women's Health Development Teams (clusters)" for skilled delivery care service utilization which explains about 62% of the total variation. Individual-level predictors including urban residence [AOR (95% CI) 35.10 (4.62, 266.52)], previous exposure of complications [AOR (95% CI) 3.81 (1.60, 9.08)], at least four ANC visits [AOR (95% CI) 7.44 (1.48, 37.42)] and preference of skilled personnel [AOR (95% CI) 8.11 (2.61, 25.15)] were significantly associated with skilled delivery service use. Among cluster level variables, the distance of clusters within 2 km radius from the nearest health facility was significantly associated [AOR (95% CI) 6.03 (1.92, 18.93)] with skilled delivery service utilization. In this study, significant variation among clusters of WHDA was observed. Both individual and cluster level

Community Living Skills Guide: Additional Activities for Nutrition, Cooking, Homemaking, and Family Living.

Science.gov (United States)

Nickovich, Marti; Kreps, Alice Roelofs

These activities are intended to supplement materials for three courses available in the Community Living Skills Guide for the College for Living series: Cooking/Food Preparation (CE 024 475), Homemaking and Family Living (CE 024 477), and Nutrition (CE 024 484). These courses for developmentally disabled adults are intended to supplement…

Childhood language skills and adolescent self-esteem in preterm survivors.

Science.gov (United States)

Islam, Umna A; Poole, Kristie L; Schmidt, Louis A; Ford, Jennifer; Saigal, Saroj; Van Lieshout, Ryan J

2018-03-01

Fifty-seven percent of children with poor language skills are affected by socio-emotional problems. Despite the importance of language skills to interpersonal functioning and school performance, relatively little is known about how they affect self-esteem in adolescence. Data on youth at high risk for language problems (e.g. those born extremely low birth weight (ELBW; self-esteem during adolescence (12-16 years) in individuals born at ELBW ( N = 138) or normal birth weight (NBW; >2500 grams) ( N = 111). Participants' language skills were assessed using the Verbal Scale of the Wechsler Intelligence Scale for Children-Revised and the Token Test at age 8. In adolescence, participants completed the Harter Self-Perception Profile for Adolescents. Birth weight status was found to moderate associations between childhood language and adolescent global self-esteem (Token Test ( p = .006), Verbal Intelligence Quotient ( p = .033)) such that better language skills were associated with higher self-esteem in adolescent ELBW survivors, but not in NBW participants. Language skills may play a protective role in the development and maintenance of self-esteem in ELBW youth and could be an important target for optimizing their functioning, particularly before transitioning to the critical adolescent period.

Community leaders can improve problem-solving skills at Virginia Tech Institute Feb. 10-12

OpenAIRE

Felker, Susan B.

2007-01-01

Development of better community problem-solving skills is the goal of the LeadershipPlenty¨ Institute to be hosted by Virginia Tech's Center for Organizational and Technological Advancement Feb. 10-12, 2008, at The Hotel Roanoke and Conference Center in Roanoke, Va.

Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania

Directory of Open Access Journals (Sweden)

Yovitha Sedekia

2017-10-01

Full Text Available Abstract Background Young adolescents and unmarried women in low and middle income countries face challenges in accessing family planning services. One factor likely to limit contraceptive use is the attitude and opinion of local stakeholders such as community leaders and health workers. Much of the existing evidence on this topic focuses on women who have already started childbearing. Using primary qualitative data, we explored individual, community and health provider’s perceptions about using modern contraceptives to delay the first birth in a high fertility setting. Methods A descriptive qualitative study was conducted in Tandahimba district in southern Tanzania between December 2014 and March 2015. We conducted 8 focus group discussions with men and women and 25 in-depth interviews (18 with women, 4 with family planning service providers and 3 with district-level staff. Participants were purposively sampled. Data transcripts were managed and coded using Nvivo 11 software and we employed a thematic framework analysis. Results Three main themes emerged about using modern contraceptives to delay first birth: (1 the social and biological status of the woman (2 the type of contraceptive and (3 non-alignment among national policies for adolescents. Use of modern contraceptives to delay first birth was widely acceptable for women who were students, young, unmarried and women in unstable marriage. But long-acting reversible methods such as implants and intrauterine devices were perceived as inappropriate methods for delaying first birth, partly because of fears around delayed return to fecundity, discontinuation once woman’s marital status changes and permanently limiting future fertility. The support for use of modern contraceptives to delay a first pregnancy was not unanimous. A small number of participants from both rural and urban areas did not approve the use of contraceptive methods before the birth of a first baby at all, not even for

The evolving role of traditional birth attendants in maternal health in post-conflict Africa: A qualitative study of Burundi and northern Uganda.

Science.gov (United States)

Chi, Primus Che; Urdal, Henrik

2018-01-01

Many conflict-affected countries are faced with an acute shortage of health care providers, including skilled birth attendants. As such, during conflicts traditional birth attendants have become the first point of call for many pregnant women, assisting them during pregnancy, labour and birth, and in the postpartum period. This study seeks to explore how the role of traditional birth attendants in maternal health, especially childbirth, has evolved in two post-conflict settings in sub-Saharan Africa (Burundi and northern Uganda) spanning the period of active warfare to the post-conflict era. A total of 63 individual semi-structured in-depth interviews and 8 focus group discussions were held with women of reproductive age, local health care providers and staff of non-governmental organisations working in the domain of maternal health who experienced the conflict, across urban, semi-urban and rural settings in Burundi and northern Uganda. Discussions focused on the role played by traditional birth attendants in maternal health, especially childbirth during the conflict and how the role has evolved in the post-conflict era. Transcripts from the interviews and focus group discussions were analysed by thematic analysis (framework approach). Traditional birth attendants played a major role in childbirth-related activities in both Burundi and northern Uganda during the conflict, with some receiving training and delivery kits from the local health systems and non-governmental organisations to undertake deliveries. Following the end of the conflict, traditional birth attendants have been prohibited by the government from undertaking deliveries in both Burundi and northern Uganda. In Burundi, the traditional birth attendants have been integrated within the primary health care system, especially in rural areas, and re-assigned the role of 'birth companions'. In this capacity they undertake maternal health promotion activities within their communities. In northern Uganda, on

Using GIS Mapping to Target Public Health Interventions: Examining Birth Outcomes Across GIS Techniques.

Science.gov (United States)

MacQuillan, E L; Curtis, A B; Baker, K M; Paul, R; Back, Y O

2017-08-01

With advances in spatial analysis techniques, there has been a trend in recent public health research to assess the contribution of area-level factors to health disparity for a number of outcomes, including births. Although it is widely accepted that health disparity is best addressed by targeted, evidence-based and data-driven community efforts, and despite national and local focus in the U.S. to reduce infant mortality and improve maternal-child health, there is little work exploring how choice of scale and specific GIS visualization technique may alter the perception of analyses focused on health disparity in birth outcomes. Retrospective cohort study. Spatial analysis of individual-level vital records data for low birthweight and preterm births born to black women from 2007 to 2012 in one mid-sized Midwest city using different geographic information systems (GIS) visualization techniques [geocoded address records were aggregated at two levels of scale and additionally mapped using kernel density estimation (KDE)]. GIS analyses in this study support our hypothesis that choice of geographic scale (neighborhood or census tract) for aggregated birth data can alter programmatic decision-making. Results indicate that the relative merits of aggregated visualization or the use of KDE technique depend on the scale of intervention. The KDE map proved useful in targeting specific areas for interventions in cities with smaller populations and larger census tracts, where they allow for greater specificity in identifying intervention areas. When public health programmers seek to inform intervention placement in highly populated areas, however, aggregated data at the census tract level may be preferred, since it requires lower investments in terms of time and cartographic skill and, unlike neighborhood, census tracts are standardized in that they become smaller as the population density of an area increases.

Reaching out: medical students leading in local communities.

Science.gov (United States)

Bannon, Aidan; O'Hare, Niamh; Corr, Michael; Sterling, Margaret; Gormley, Gerard J

2015-06-01

Queen's University Red Cross is a medical student-led volunteer group with a key aim of promoting social change within local communities and empowering young people to aspire to higher education. We describe 'The Personal Development Certificate', a 12-week community development programme devised by third-year medical students at Queen's University Belfast to target young people who are lacking educational motivation, are disengaged at home or are marginalised through social circumstances. Community-based education is of increasing importance within undergraduate and postgraduate medical education in the UK, and further afield. We evaluated the perceived improvements in key skills such as teamwork, leadership, communication, and problem solving in students following participation in this programme, and the extent to which their attitude and appreciation of community-based medicine changed. [Students] appreciated the opportunity to translate a series of classroom-learned skills to real-life environments Following facilitation of this community-based initiative, all students reported a perceived improvement in the acquired skill sets. Students made strong links from this programme to previous clinical experiences and appreciated the opportunity to translate a series of classroom-learned skills to real-life environments and interactions. The students' appreciation and understanding of community-based medicine was the single most improved area of our evaluation. We have demonstrated that medical students possess the skills to develop and facilitate their own educational projects. Non-clinical, student-led community projects have the potential to be reproduced using recognised frameworks and guidelines to complement the current undergraduate medical curriculum. © 2015 John Wiley & Sons Ltd.

Ecological analysis of secular trends in low birth weight births and adult height in Japan.

Science.gov (United States)

Morisaki, Naho; Urayama, Kevin Yuji; Yoshii, Keisuke; Subramanian, S V; Yokoya, Susumu

2017-10-01

Japan, which currently maintains the highest life expectancy in the world and has experienced an impressive gain in adult height over the past century, has suffered a dramatic twofold increase in low birth weight (LBW) births since the 1970s. We observed secular trends in birth characteristics using 64 115 249 live births included the vital statistics (1969-2014), as well as trends in average height among 3 145 521 adults born between 1969 and 1996, included in 79 surveys conducted among a national, subnational or community population in Japan. LBW rates exhibited a U-shaped pattern showing reductions until 1978-1979 (5.5%), after which it increased. Conversely, average adult height peaked for those born during the same period (men, 171.5 cm; women, 158.5 cm), followed by a reduction over the next 20 years. LBW rate and adult height showed a strong inverse correlation (men, r=-0.98; women, r=-0.88). A prediction model based on birth and economical characteristics estimated the national average of adult height would continue to decline, to 170.0cm (95% CI 169.6 to 170.3) for men and 157.9cm (95% CI 157.5 to 158.3) for women among those born in 2014. Adult height in Japan has started to decline for those born after 1980, a trend that may be attributed to increases in LBW births over time. Considering the known association between shorter adult height and adverse health outcomes, evidence of population-level decline in adult health due to long-term consequences of increasing LBW births in Japan is anticipated. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Use of Modern Birth Control Methods Among Rural Communities in ...

African Journals Online (AJOL)

elearning

ABSTRACT. This paper studied the extent of utilization of Modern Birth Control Methods (MBCM) among rural dwellers in ... respondents used MBCM while 57% of them used the traditional birth control methods. ..... School of Public Health.

Women’s Health Decision-Making Autonomy and Skilled Birth Attendance in Ghana

Directory of Open Access Journals (Sweden)

Edward Kwabena Ameyaw

2016-01-01

Full Text Available Delivering in health facility under the supervision of skilled birth attendant is an important way of mitigating impacts of delivery complications. Empirical evidence suggests that decision-making autonomy is aligned with holistic wellbeing especially in the aspect of maternal and child health. The objective of this paper was to examine the relationship between women’s health decision-making autonomy and place of delivery in Ghana. We extracted data from the 2014 Ghana Demographic and Health Survey. Descriptive and logistic regression techniques were applied. The results indicated that women with health decision-making autonomy have higher tendency of health facility delivery as compared to those who are not autonomous [OR = 1.27, CI = 1.09–1.48]. However, those who have final say on household large purchases [OR = 0.71, CI = 0.59–0.84] and those having final say on visits [OR = 0.86, CI = 0.73–1.01] were less probable to deliver in health facility than those without such decision-making autonomy. Consistent with existing evidence, wealthier, urban, and highly educated women had higher inclination of health facility delivery. This study has stressed the need for interventions aimed at enhancing health facility delivery to target women without health decision-making autonomy and women with low education and wealth status, as this can play essential role in enhancing health facility delivery.

The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community

Directory of Open Access Journals (Sweden)

Catherine L. Kothari

2016-12-01

Full Text Available This study examined the interrelationship of race and socioeconomic status (SES upon infant birthweight at the individual and neighborhood levels within a Midwestern US county marked by high Black infant mortality. The study conducted a multi-level analysis utilizing individual birth records and census tract datasets from 2010, linked through a spatial join with ArcGIS 10.0. The maternal population of 2861 Black and White women delivering infants in 2010, residing in 57 census tracts within the county, constituted the study samples. The main outcome was infant birthweight. The predictors, race and SES were dichotomized into Black and White, low-SES and higher-SES, at both the individual and census tract levels. A two-part Bayesian model demonstrated that individual-level race and SES were more influential birthweight predictors than community-level factors. Specifically, Black women had 1.6 higher odds of delivering a low birthweight (LBW infant than White women, and low-SES women had 1.7 higher odds of delivering a LBW infant than higher-SES women. Moderate support was found for a three-way interaction between individual-level race, SES and community-level race, such that Black women achieved equity with White women (4.0% Black LBW and 4.1% White LBW when they each had higher-SES and lived in a racially congruous neighborhood (e.g., Black women lived in disproportionately Black neighborhood and White women lived in disproportionately White neighborhood. In sharp contrast, Black women with higher-SES who lived in a racially incongruous neighborhood (e.g., disproportionately White had the worst outcomes (14.5% LBW. Demonstrating the layered influence of personal and community circumstances upon health, in a community with substantial racial disparities, personal race and SES independently contribute to birth outcomes, while environmental context, specifically neighborhood racial congruity, is associated with mitigated health risk. Keywords: Birth

Introducing a multimedia course to enhance health professionals' skills to facilitate communities of practice.

Science.gov (United States)

Jakubec, Sonya L; Parboosingh, John; Colvin, Barbara

2014-01-01

Scholarship about communities of practice (COP) is uncovering evidence that interactivity between community members contributes to improvement in practice. Leadership and facilitation are crucial elements of successful COP implementation. The purpose of this paper is to describe an innovative COP facilitator's course and report on the experiences of participants in the first course. In response to this need and emerging evidence, an on-line COP facilitator's course was developed and implemented in Alberta, Canada, in 2011. This course included a home-based COP practicum, introductory face-to-face session, an on-line discussion board moderated by faculty and on-line learning modules. Evaluation of the course was formalized in a qualitative study incorporating content analysis of postings, semi-structured interviews of successful participants and narrative responses to questions in a post course survey. A total of 15 of 22 participants perceived they acquired basic knowledge about community facilitation by completing the self-learning modules and assignments. Many did not establish home-based COP and only partially participated in the interactive components of the course. Six participants successfully completed the course by establishing home-based COP and actively participating in the social and interactive components of the course. They perceived they met course objectives and greatly benefited from participation in the course, in particular when they pushed themselves to facilitate in new and different ways, and when they were actively engaged with their home-based COP where they could practice and receive feedback. While the main reasons why participants dropped out or failed to complete all course components were reported, the experiences and perceptions of six participants who successfully completed all course components form the major part of the evaluation of the course and hence introduce bias. A more in depth analysis of why learners are reluctant to engage

Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010.

Directory of Open Access Journals (Sweden)

Lin Xiao

Full Text Available Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35% in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related.This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340, other First Nations (n = 10,810 and non-Aboriginal (n = 229,960 communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality.Macrosomia (birth weight for gestational age >90th percentile was substantially more frequent in Cree (38.0% and other First Nations (21.9% vs non-Aboriginal (9.4% communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1.52 (95% confidence intervals 1.17, 1.98 and 1.34 (1.10, 1.64 times higher, and infant mortality rates 2.27 (1.71, 3.02 and 1.49 (1.16, 1.91 times higher, respectively. The risk elevations in perinatal and infant death in Cree communities attenuated after adjusting for maternal characteristics (age, education, marital status, parity, but became greater after further adjustment for birth weight (small, appropriate, or large for gestational age.Cree communities had greater risk elevations in perinatal and infant mortality than other First Nations relative to non-Aboriginal communities in Quebec. High prevalence of macrosomia did not explain the elevated risk of perinatal and infant mortality in Cree communities.

Community Based Informatics: Geographical Information Systems, Remote Sensing and Ontology collaboration - A technical hands-on approach

Science.gov (United States)

Branch, B. D.; Raskin, R. G.; Rock, B.; Gagnon, M.; Lecompte, M. A.; Hayden, L. B.

2009-12-01

With the nation challenged to comply with Executive Order 12906 and its needs to augment the Science, Technology, Engineering and Mathematics (STEM) pipeline, applied focus on geosciences pipelines issue may be at risk. The Geosciences pipeline may require intentional K-12 standard course of study consideration in the form of project based, science based and evidenced based learning. Thus, the K-12 to geosciences to informatics pipeline may benefit from an earth science experience that utilizes a community based “learning by doing” approach. Terms such as Community GIS, Community Remotes Sensing, and Community Based Ontology development are termed Community Informatics. Here, approaches of interdisciplinary work to promote and earth science literacy are affordable, consisting of low cost equipment that renders GIS/remote sensing data processing skills necessary in the workforce. Hence, informal community ontology development may evolve or mature from a local community towards formal scientific community collaboration. Such consideration may become a means to engage educational policy towards earth science paradigms and needs, specifically linking synergy among Math, Computer Science, and Earth Science disciplines.

Situation Analysis Report. Stafford County, 2013

OpenAIRE

2015-01-01

Contains demographic data on age, teen birth rate, household income, changes in farm acreage. Some results of an issue-based community survey are presented, including teen community involvement, life skills training for youth, youth violence, parenting, nutrition, science and technology, and the environment.

Leveraging 3D Technology for Students with Autism: An innovative university-community collaboration for skill development and vocational exploration

Directory of Open Access Journals (Sweden)

Cheryl A Wright

2017-06-01

Full Text Available This article describes a university-community collaboration in which an inter-professional team partnered to provide students with autism spectrum disorder (ASD a paid job opportunity to apply 3D modelling skills for a local construction company. Providing meaningful vocational opportunities to improve the transition to adulthood for individuals with ASD is imperative, as individuals with ASD have unemployment rates that are some of the highest of all disabilities. This novel evidence-supported educational program was designed to develop 3D technology skills, explore vocational careers and promote social engagement through shared interests for transition-age youth with ASD. Both parents and students reported many successful outcomes, including increase in student self-confidence, social and technology skill development and the opportunity for vocational exploration by these young people. Implications of the case study are reported in relation to university-community partnerships and the critical role of community collaboration in addressing the high rates of unemployment in individuals with autism.

The role of support person for Ngaanyatjarra women during pregnancy and birth.

Science.gov (United States)

Simmonds, Donna M; West, Lalla; Porter, Julie; Davies, Melva; Holland, Carol; Preston-Thomas, Annie; O'Rourke, Peter K; Tangey, Annie

2012-06-01

This study took place in a remote community on the Ngaanyatjarra Lands, Western Australia. Ngaanyatjarra women's cultural practices have been subject to erosion during the past 70 years. Women are now expected to birth hundreds of kilometres from home and, due to financial barriers, without family support. Older women lament their lack of input into, and control of, contemporary birthing services. In order to provide culturally appropriate maternity services we asked: What issues would the Ngaanyatjarra women of the community like to see resolved in the area of antenatal and birthing services? Eligible participants were any Ngaanyatjarra women of the study community who had birthed at least once. We utilised a participatory research methodology. 36 women were interviewed. This paper discusses one finding related to support for child-bearing women. The role is important in many ways. Ngaanyatjarra women did not traditionally have their support persons with them during labour and birth, nor do they necessarily expect them to be present in current times. Most women do, however, wish to have a support person with them during antenatal checkups and when they travel to town to await birth. Aboriginal women from remote communities should be able to have a support person with them when they access regional birthing services, but the nature of this role must not be assumed. A culturally appropriate service has input from the community, provides options and respects choices. Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Motivational, Parental, and Cultural Influences on Achievement and Persistence in Basic Skills Mathematics at the Community College

Science.gov (United States)

Nordstrom, Donna E.

2012-01-01

The purpose of this study was to address the gap in the current literature on community college students in basic math courses by examining motivational, parental and cultural factors as predictors of achievement and persistence of students enrolled in basic skills mathematics courses at a community college. More specifically, this study…

Skills acquired in research and public health in the specialty of family and community nursing in the Valencian Community.

Science.gov (United States)

García-Martínez, Pedro; Lozano-Vidal, Ruth; Herraiz-Ortiz, María Del Carmen; Collado-Boira, Eladio

To evaluate the acquisition of skills in research and public health specialists in family and community nursing. Descriptive and analytical study on a population of specialist nurse members of with the Valencian Primary Nurse Society. Measured with anonymous self-administered questionnaire on activities implemented and turnaround time in the training period. The questionnaire was conducted and reviewed based on the training programme of the specialty. Sixteen of the 41 specialists responded. The four year groups of nurses who had finished their training were represented as well as seven national teaching units. The results show high heterogeneity in the activities developed in the training. The average rotation in public health is 7.07 weeks, with range of 0 to 16 weeks. The mean number of educational sessions is 2.69 in the two years. The average number of research projects is 1.19. The result shows a specialisation process with training gaps in the skills of research and public health that could be remedied. Some practitioners claim that they finish their specialisation without undertaking research activities or completing the minimum proposed shifts. There is no process of improvement in the four year groups studied. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

American Indian Community Colleges.

Science.gov (United States)

One Feather, Gerald

With the emergence of reservation based community colleges (th Navajo Community College and the Dakota Community Colleges), the American Indian people, as decision makers in these institutions, are providing Indians with the technical skills and cultural knowledge necessary for self-determination. Confronted with limited numbers of accredited…

Birth planning in Cuba: a basic human right.

Science.gov (United States)

Swanson, J M

1981-01-01

This paper reports on the development of birth planning in Cuba and strategies that are relevant to nurses in the communities of Cuba. Cuba reduced its crude birth rate by 40% from 1964-75 without formal family planning programs and resources. By 1975, Cuba had achieved the lowest birth rate in Latin America (21/1000) except Barbados (19/1000). By 1978, Cuba's crude birth rate declined to a low of 15.3/1000. The demographic transition in Cuba has been a process of equalization by: 1) community participation to ensure basic human rights for everyone, 2) increasing the status of women while providing child care centers, 3) providing equal availability of health care services including contraceptive services, sterilization, and abortion, and 4) focusing on individual birth choice, not on limiting population growth. Emphasis in Cuba for reducing fertility has been put on literacy, education, and infant mortality. The illiteracy rate in 1961 decreased from 20% to 4%. Infant mortality decreased from 38.8/1000 live births in 1970 to 22.3/1000 in 1978. 1/3 of Cuban women were participating fully in the labor force in 1978. Polyclinics have been established as preventive care medical centers throughout Cuba and health care is free. Family planning options are integrated into routine primary health care at polyclinics and assure equal access to the total Cuban population. Abortion is freely available and increased to 61/1000 in 1976. The implications for nursing are that: 1) the traditional work of nurses places them in a key position to help extend basic human rights beyond current levels, 2) nurses can initiate discussions of birth planning with women and men in a variety of settings, and 3) nurses can increase case-finding related to birth planning needs both in health care classes or within established groups in the community.

Training community health students to develop community-requested social marketing campaigns: an innovative partnership.

Science.gov (United States)

Lindsey, Billie J; Hawk, Carol Wetherill

2013-01-01

This paper describes a sustained partnership between a university community health program and local and regional community health agencies. As a key component of the Health Communication and Social Marketing course, the partnership involves undergraduate community health students working for and with community agencies and community members to design social marketing campaigns based on community-identified health needs. The goals of the course are to (1) provide students with the opportunity to work within the community to apply their skills in program planning, evaluation, and communication and (2) provide community agencies with a tailored campaign that can be implemented in their communities. Throughout the 10-week quarter, teams of students follow the principles of community participation in planning a social marketing campaign. These include (1) audience segmentation and formative assessment with the intended audience to determine campaign content and strategies and (2) pretesting and revisions of campaign messages and materials based on community feedback. This partnership contributes to the promotion of health in the local community and it builds the skills and competencies of future health educators. It demonstrates a successful and sustainable combination of community-based participatory research and experiential learning. From 2005 to 2011, 35 campaigns have been developed, many which have been implemented.

Traditional Birth Attendant Training and Local Birthing Practices in India

Science.gov (United States)

Saravanan, Sheela; Turrell, Gavin; Johnson, Helen; Fraser, Jenny; Patterson, Carla

2011-01-01

Training birth attendants (TBAs) to provide essential maternal and infant health care services during delivery and ongoing community care in developing countries. Despite inadequate evidence of relevance and effectiveness of TBA training programmes, there has been a policy shift since the 1990s in that many donor agencies funding TBA training…

The effectiveness of community-based cycling promotion: findings from the Cycling Connecting Communities project in Sydney, Australia

Directory of Open Access Journals (Sweden)

Merom Dafna

2010-01-01

Full Text Available Abstract Background Encouraging cycling is an important way to increase physical activity in the community. The Cycling Connecting Communities (CCC Project is a community-based cycling promotion program that included a range of community engagement and social marketing activities, such as organised bike rides and events, cycling skills courses, the distribution of cycling maps of the area and coverage in the local press. The aim of the study was to assess the effectiveness of this program designed to encourage the use of newly completed off-road cycle paths through south west Sydney, Australia. Methods The evaluation used a quasi-experimental design that consisted of a pre- and post-intervention telephone survey (24 months apart of a cohort of residents (n = 909 in the intervention area (n = 520 (Fairfield and Liverpool and a socio-demographically similar comparison area (n = 389 (Bankstown. Both areas had similar bicycle infrastructure. Four bicycle counters were placed on the main bicycle paths in the intervention and comparison areas to monitor daily bicycle use before and after the intervention. Results The telephone survey results showed significantly greater awareness of the Cycling Connecting Communities project (13.5% vs 8.0%, p Conclusion Despite relatively modest resources, the Cycling Connecting Communities project achieved significant increases in bicycle path use, and increased cycling in some sub-groups. However, this community based intervention with limited funding had very limited reach into the community and did not increase population cycling levels.

Impact on postpartum hemorrhage of prophylactic administration of oxytocin 10 IU via Uniject™ by peripheral health care providers at home births: design of a community-based cluster-randomized trial.

Science.gov (United States)

Stanton, Cynthia K; Newton, Samuel; Mullany, Luke C; Cofie, Patience; Agyemang, Charlotte Tawiah; Adiibokah, Edward; Darcy, Niamh; Khan, Sadaf; Levisay, Alice; Gyapong, John; Armbruster, Deborah; Owusu-Agyei, Seth

2012-06-07

Hemorrhage is the leading direct cause of maternal death globally. While oxytocin is the drug of choice for postpartum hemorrhage prevention, its use has generally been limited to health facilities. This trial assesses the effectiveness, safety, and feasibility of expanding the use of prophylactic intramuscular oxytocin to peripheral health care providers at home births in four predominantly rural districts in central Ghana. This study is designed as a community-based cluster-randomized trial in which Community Health Officers are randomized to provide (or not provide) an injection of oxytocin 10 IU via the Uniject™ injection system within one minute of delivery of the baby to women who request their presence at home at the onset of labor. The primary aim is to determine if administration of prophylactic oxytocin via Uniject™ by this cadre will reduce the risk of postpartum hemorrhage by 50 % relative to deliveries which do not receive the prophylactic intervention. Postpartum hemorrhage is examined under three sequential definitions: 1) blood loss ≥500 ml (BL); 2) treatment for bleeding (TX) and/or BL; 3) hospital referral for bleeding and/or TX and/or BL. Secondary outcomes address safety and feasibility of the intervention and include adverse maternal and fetal outcomes and logistical concerns regarding assistance at home births and the storage and handling of oxytocin, respectively. Results from this trial will build evidence for the effectiveness of expanding the delivery of this established prophylactic intervention to peripheral settings. Complementary data on safety and logistical issues related to this intervention will assist policymakers in low-income countries in selecting both the best uterotonic and service delivery strategy for postpartum hemorrhage prevention. Results of this trial are expected in mid-2013. The trial is registered at ClinicalTrials.gov: NCT01108289.

Delivering at home or in a health facility? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania.

Science.gov (United States)

Pfeiffer, Constanze; Mwaipopo, Rosemarie

2013-02-28

Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women's health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including

Community-based medical education: is success a result of meaningful personal learning experiences?

Science.gov (United States)

Kelly, Len; Walters, Lucie; Rosenthal, David

2014-01-01

Community-based medical education (CBME) is the delivery of medical education in a specific social context. Learners become a part of social and medical communities where their learning occurs. Longitudinal integrated clerkships (LICs) are year-long community-based placements where the curriculum and clinical experience is typically delivered by primary care physicians. These programs have proven to be robust learning environments, where learners develop strong communication skills and excellent clinical reasoning. To date, no learning model has been offered to describe CBME. The characteristics of CBME are explored by the authors who suggest that the social and professional context provided in small communities enhances medical education. The authors postulate that meaningfulness is engendered by the authentic context, which develops over time. These relationships with preceptors, patients and the community provide meaningfulness, which in turn enhances learning. The authors develop a novel learning model. They propose that the context-rich environment of CBME allows for meaningful relationships and experiences for students and that such meaningfulness enhances learning.

An Investigation of Higher-Order Thinking Skills in Smaller Learning Community Social Studies Classrooms

Science.gov (United States)

Fischer, Christopher; Bol, Linda; Pribesh, Shana

2011-01-01

This study investigated the extent to which higher-order thinking skills are promoted in social studies classes in high schools that are implementing smaller learning communities (SLCs). Data collection in this mixed-methods study included classroom observations and in-depth interviews. Findings indicated that higher-order thinking was rarely…

Area-level poverty and preterm birth risk: A population-based multilevel analysis

Science.gov (United States)

DeFranco, Emily A; Lian, Min; Muglia, Louis A; Schootman, Mario

2008-01-01

Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997). We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990). Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty) was the reference group. Results PTB rate of PTB poverty and increased through the 4th quartile (4.9%), p poverty was significantly associated with PTB risk. PTB risk (poverty, adjusted odds ratio (adjOR) 1.18 (95% CI 1.03, 1.35), with a similar effect at earlier gestational ages (birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies. PMID:18793437

Area-level poverty and preterm birth risk: A population-based multilevel analysis

Directory of Open Access Journals (Sweden)

Muglia Louis A

2008-09-01

Full Text Available Abstract Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997. We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990. Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty was the reference group. Results PTB th quartile (4.9%, p adjOR 1.18 (95% CI 1.03, 1.35, with a similar effect at earlier gestational ages (adjOR 1.27 (95% CI 1.06, 1.52. Conclusion Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

What can a meta-analysis tell us about traditional birth attendant training and pregnancy outcomes?

Science.gov (United States)

Sibley, Lynn; Ann Sipe, Theresa

2004-03-01

to summarise the available published and unpublished studies on traditional birth attendant (TBA) training effectiveness. a meta-analysis. sixty studies (n=60) spanning 1971-1999 from 24 countries and three regions. the effect size index, Cohen's h for each outcome; the variance-weighted mean effect size and 95% confidence interval for sub-group of outcomes; homogeneity tests on the distribution of the weighted mean effect sizes; and sensitivity analysis to detect the presence of publication bias. TBA training was associated with significant increases in attributes such as TBA 'knowledge' (90%), 'attitude' (74%), 'behaviour' (63%) and 'advice' (90%) over the untrained TBA baseline. Results for 'behaviour' and 'advice' in specific content areas related to peri-neonatal health outcome, however, reveal sources of variability and underscore the conflicting evidence on TBA training. TBA training was also associated with small but significant decreases in peri-neonatal mortality (8%) and birth asphyxia mortality (11%). Incomplete reporting limited the assessment of neonatal mortality due to tetanus and acute respiratory infection, maternal mortality, as well as assessment of the relationship between intervention characteristics and outcomes. The quality of studies included in the meta-analysis lack sufficient rigour to address the question of causality. Thus, while the data suggest that TBA training is effective in terms of the outcomes measured, we are unable to demonstrate that it is a cost-effective intervention. skilled attendance at birth is a distant reality in many developing countries and effective community-based strategies are needed to help reduce high levels of mortality. Given the magnitude of peri-neonatal mortality, the associations observed between TBA training peri-neonatal and birth asphyxia mortality, and TBA attributes in content relevant to peri-neonatal survival, we suggest that these strategies may usefully include TBA training in appropriate

Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review.

Science.gov (United States)

Coast, Ernestina; Jones, Eleri; Lattof, Samantha R; Portela, Anayda

2016-12-01

Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations' use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations' access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.