160 research outputs found
Child Injuries and Deaths from Road Traffic Incidents in Ghana: Informing Policy and Practice
No full textThesis (Master's)--University of Washington, 2023University of Washington ABSTRACTChild injuries and deaths from road traffic incidents in Ghana: informing policy and practice
Sulemana Abdul-Matinue
Chair of the Supervisory Committee:
Caryl Feldacker, MPH, PhD
Department of Global Health Background: Road traffic crashes are a major public health concern globally; low middle-income countries bear the greatest burden. The Sub-Saharan region accounts for 35.2% child deaths globally due to RTI. The burden of road traffic injuries in Ghana among children is alarming and impacts the lives of Ghanaian children. The world health organization announced a second Decade of Action to achieve their target of reducing RTCs by the year 2030. However, in Ghana, the decade of action is yet to yield any results. The study aimed to report on the annual fatal rates of road traffic injuries (RTI) and to describe the fatal and non-fatal patterns of road traffic crash characteristics among children under 15 years in Ghana from 2005-2020.Methods: We employ Ghana's Building and Roads Research Institute (BRRI) database which includes detailed information on each police reported Road Traffic Crashes (RTC), Road Traffic Injury (RTI), and Road Traffic Fatality (RTF) from 2005 to 2020 in Ghana as of 2022. Descriptive analysis of variables such as sex, vehicle type, gender, age, road conditions were analyzed. Crashes stratified as either injury or death and Chi square test used to determine the relationship between dependent and independent variables.
Results: Pedestrian RTCs were the leading cause of injuries and deaths among these age groups over the last 16 years. It is coming down but remains the leading cause. The overall average road crash fatality was 3.35 per 100,000 population with children aged 10-14 group being the most affected. The number of males involved in road traffic crashes were more than females (p=0.001). The Highest proportion of childhood road traffic injuries and deaths were caused by cars including both children riding in cars that crashed, and children struck by cars. Good tar road conditions contributed to many road traffic crashes involving children (73.5%).
Conclusion: This study showed overwhelming evidence of road traffic crashes on pedestrians, primarily males aged 10-14 years old. Targeted interventions aimed at improving the road environment, construction of speed bumps, sidewalks, overheard crossings, provision of safe playing and walking space for children and adolescents will help reduce the avoidable deaths on our roads
“Endless Opportunities”: A Qualitative Study on Improving Two-Way Texting For Medical Male Circumcision Clients In Zimbabwe
No full textThesis (Master's)--University of Washington, 2022Background: Evidence shows that voluntary medical male circumcision (VMMC) as a one-time prevention method is a cost-effective way to reduce HIV transmission. In Zimbabwe, there is an HIV prevalence of 14.6% among adults, and health systems are strained due to healthcare worker (HCW) shortages. Digital health innovations, such as two-way texting (2wT), could help achieve the desired scale-up of VMMC programs and reduce HCW burden. 2wT-based, interactive follow-up was found to be cost-effective, beneficial to post-operative care, and positively perceived by both patients and HCWs. However, there have been some barriers in the transition from clinical trial to scale-up as part of routine care. To better understand the barriers to 2wT implementation as part of the larger VMMC national strategy, hearing directly from program partners about the challenges they are facing is essential.Methods: An exploratory qualitative study was conducted to identify the successes and challenges of the 2wT program in order to inform future scale-up efforts. Sixteen in-depth interviews were conducted with 2wT program partners that participated in the design, implementation, scale up, or maintenance of the ZAZIC Consortium’s 2wT program, including staff from within the Consortium, as well as program partner Medic, and Ministry of Health and Child Care site nurses. Partners were interviewed on the successes, challenges, and possible improvements of the 2wT program. A combination of inductive and deductive methods was used during data analysis which was conducted using ATLAS.ti.
Results: Program partners who participated in this study largely felt that the successes of the 2wT program outweighed any challenges but shared potential ways that the program could be improved. Program successes included community buy-in, a strong foundational training, and usability of the 2wT app for both HCWs and clients. Factors identified that constrained program function and scale-up consisted of poor mobile network coverage, clients needing to buy airtime, and shortages of 2wT trained HCWs. Partners also discussed strategies to further improve the program, including exploring the optimal number of text messages, cascading the 2wT training, and updating the 2wT system to allow family members, especially youth, to register with the same phone number.
Discussion: ZAZIC’s 2wT program highlights the importance of a community-driven approach throughout the various stages of implementation. Indeed, other mobile health studies found that partners who are able to provide numerous rounds of feedback may be more invested and engaged in health programs, something that could be linked with the high levels of 2wT community buy-in partners discussed. Furthermore, this study emphasizes the importance of an iterative process for optimization of care, and the need to adjust and adapt 2wT systems to specific contexts
Reducing the burden of road traffic injuries and deaths in Ghana: an implementation science approach
No full textThesis (Ph.D.)--University of Washington, 2023This dissertation comprises four studies that aim to develop contextually relevant evidence on high-risk areas and factors for targeted road traffic injury prevention initiatives in Ghana. We use an implementation science approach by conducting research to understand areas and populations at greater risk that may benefit from evidence-based policies and interventions. The first three studies use a longstanding database maintained by the Building and Road Research Institute of each police-reported motor vehicle collision, minor injury, severe injury, and death. The last study involves in-depth interviews with 24 people in high-risk areas of major roads in Ghana. In Chapter 1, we provide background on road traffic injuries and deaths, our research objectives, and our approach. In Chapter 2, we identify spatial-specific and precise (i.e., 100-meter locations) clusters of road traffic injury severity on major roads in rural and urban areas of Ghana using the Getis-Ord Gi* statistic in ArcGIS Pro. We map 35,109 road traffic events from 2017 to 2020 on major roads and weigh outcomes based on severity using a well-known injury severity index. We observed 223 hot spots in rural areas (6.2% of the road network) and 142 injury severity hot spots in urban areas (4.7%) of the road network to target for injury control. We find critical patterns in both types of hot spots, including that urban hot spots are often in the peripheral area of cities where major roads intersect, whereas rural hot spots are sporadic.
In Chapter 3, we analyze spatiotemporal trends in road traffic injury severity, minor injuries, severe injuries, and deaths from 2005 to 2020 using space-time data mining tools (i.e., a space-time cube and emerging hot spot analysis) in ArcGIS Pro. We find the injury severity index and minor injuries significantly decreasing over the period while severe injuries and deaths are on the rise. We identify three specific 2 kilometers (km) by 2 km urban areas and 29 2 km by 2 km rural areas, which are intensifying, defined as hot spots for 90% of the 16 years and with increasing injury severity index scores.
In Chapter 4, we use five years of data (2016 to 2020) to assess and compare factors associated with injury severity among vulnerable road users (VRUs), defined as those without external protection (e.g., pedestrians, powered two-wheeler occupants), to non-vulnerable. We find some factors that consistently increase the odds of severe outcomes, including head-on collisions, at night with no lights or the lights off, and in rural areas or villages. We also explore and compare VRU subgroups (powered two-wheeler occupants, powered three-wheeler occupants, cyclists, and pedestrians) and find substantial heterogeneity in the factors associated with injury severity. Findings indicate that a targeted and road user-specific injury prevention approach is warranted. Targeted interventions for each sub-group could include interventions related to nighttime risks (e.g., lighting, enforcement to reduce excessive speeding) for powered two-wheelers, improved regulation for passengers of powered three-wheelers, and pedestrian-oriented infrastructure.
Lastly, Chapter 5 explores road user perspectives on the magnitude, contributing factors, and potential solutions for road traffic injuries and deaths. We find that participants feel excluded from road safety design, planning, and implementation efforts, despite their complex understanding of the problem’s magnitude and contributing factors. An emerging theme was that socio-economic conditions affect increased risks related to road traffic collisions, injuries, and deaths. For example, participants noted that roadside sellers were at higher risk because of their precarious economic status, requiring them to spend substantial time on busy, high-speed roads. Participants describe key implementation issues related to existing interventions, such as a lack of enforcement at certain places or times and poorly designed and built speed calming measures. When prompted for potential solutions, many road users focused on road user behavior and the need for increased enforcement, reflecting a national and global emphasis on changing road user behavior. We call for greater community involvement in road safety to adapt interventions to meet local needs and for the government to acknowledge the gravity of this crisis and allocate resources accordingly
Part of the Process: Transitioning HIV Program Management from U.S.-based to Local Partners in Zimbabwe
No full textThesis (Master's)--University of Washington, 2021BACKGROUND: Despite the history of U.S.-based partners leading global health programs in low- and middle-income (LMIC) countries, sustainable models of health care rely on local country partners leading the way. Transition is the process of shifting funder-led programs towards country ownership, where local stakeholders plan, manage, deliver, and finance their health sector. However, transition also encompasses earlier steps where local organizations lead and manage programs but still rely on U.S.-based funding. This phase is scarcely described yet threatens long-term program sustainability if navigated too quickly or with poor outcome. METHODS: This qualitative study examines the transition of Zimbabwe’s voluntary medical male circumcision (VMMC) services and HIV prevention, treatment, care, and support services (C&T) programs from management by a U.S.-based organization, the International Training and Education Center for Health (I-TECH), to Zimbabwean management under a new local organization, the Zimbabwe Technical Assistance, Training and Education Centre for Health (Zim-TTECH). The primary objective is to explore challenges, successes, and lessons learned during transition to guide future non-governmental organizations (NGOs) entering similar processes. We conducted sixteen key informant interviews among transition team staff from I-TECH and Zim-TTECH who are based in the U.S. and Zimbabwe, respectively. RESULTS: Findings suggest five major themes to guide the process of transition: 1) Develop a vision and empower leadership for change; 2) Plan and strategize for transition; 3) Communicate with and inform stakeholders; 4) Engage and mobilize staff; 5) Define short-term and long-term success. Additional sub-themes capture the role of local context in mediating transition processes, transition perceptions and their role in mediating transition-related communication, and development of critical infrastructure and staff capacity. CONCLUSION: Local country context, short transition timelines, and indicators of transition success challenged the transition process whereas strong local staff capacity and a synergistic partnership between Zim-TTECH and I-TECH supported success. Change management frameworks suggest transition is not complete when success is defined, but once the organization consolidates gains from the change process and anchors changes in the culture. Funders, international partner organizations, and local organizations should consider their role in enabling a smooth transition process and empowering greater country ownership in the long term
REDCap for Improved M&E of Voluntary Medical Male Circumcision Outreach
No full textThesis (Master's)--University of Washington, 2021IntroductionVoluntary Medical Male Circumcision (VMMC) reduces HIV transmission rate by up to 60%. There is a great need for VMMC services in Zimbabwe, where the HIV prevalence is one of the highest in the world at 12.9%. The ZAZIC consortium was founded in 2013 to expand VMMC services in Zimbabwe. In 2019, ZAZIC transitioned its VMMC outreach data collection practices from weekly paper forms to daily electronic forms submitted via REDCap, aiming to optimize data collection and decrease reporting errors and confidentiality risks.
Methods
This convergent mixed-methods, retrospective, cross-sectional analysis evaluates the transition to electronic data collection to aid VMMC program monitoring and evaluation (M&E) in Zimbabwe between July 2019 and March 2020. Study 1 assessed organizational uptake of utilizing electronic data collection via RedCap for routine VMMC program monitoring in Zimbabwe using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Study 2 identified factors contributing to VMMC program success using a mixed-methods analysis.
Results
RE-AIM analysis established REDCap as an effective data collection tool with improved data quality. Results from linear regression models revealed program factors such as increased outreach resources and community-based demand creation were significantly associated with VMMCs throughout ZAZIC and within the target 15-29 age group. Qualitative analysis provided further insight to quantitative results by providing explanations as to why factors such as demand creation were so successful in increasing outreach.
Conclusion
REDCap is effective for VMMC outreach data collection. These findings will inform future program monitoring and evaluation practices among ZAZIC partner
Is it who you are or where you live? A mixed-method exploration of associations between people and place in the context of HIV in rural Malawi
No full textIn Malawi, approximately 1 million people are infected with Human Immunodeficiency Virus (HIV). Infection rates are decreasing in urban areas; the opposite is true for rural populations. Individual-level risk factors influence patterns of HIV in Malawi. However, area-level socio-economic and access factors may play critical roles in driving HIV, and these factors are rarely investigated. To address this gap, this research uses a nationally-representative probability sample of rural Malawians linked to spatially-oriented, area-level socio-economic and access data to address two specific aims: 1) to reveal relationships between area-level factors and individual HIV status and determine whether individual risk behaviors mediate these associations using logistic regression; and, 2) to explore how relationships between area- and individual-level risks and individual HIV status vary in space using geographically weighted regression. Analysis is stratified to examine the role of gender. Area-level factors include income inequality and absolute poverty as well as proximity to roads, cities, and health clinics. Mediators include condom use, sexually transmitted infections, multiple partnerships, and, for men, paid sex. Results indicate that both people and place matter in the context of HIV in rural Malawi. Among women, high income inequality and proximity to a major road are associated with increased odds of HIV while the negative association between distance to healthcare and HIV status is mediated by individual behavior. For men, living further from a health clinic decreases the odds of HIV infection. Spatial models provide additional detail, illustrating local-level variation in these associations. Women further from health clinics, major roads, and major cities are less likely to be infected in specific geographic areas. HIV status among men is closely associated with migration patterns in distinct locations. As informed by the Political Economy of Health theory, this study confirms that area-level socio-economic and access factors influence HIV in rural Malawi. Associations vary by gender and in space and are largely not mediated by individual behavior. The findings suggest that inequality has deleterious effects on women, and that spatial isolation may lead to social isolation for both genders, decreasing HIV risk. These results could inform tailored HIV prevention efforts in rural Malawi
The who and where of HIV in rural Malawi: Exploring the effects of person and place on individual HIV status
No full textFew spatial studies explore relationships between people and place in sub-Saharan Africa or in the context of Human Immunodeficiency Virus (HIV). This paper uses individual-level demographic and behavioral data linked to area-level, spatially-referenced socio-economic and access data to examine how the relationships between area- and individual-level risks and individual HIV status vary in rural Malawi. The Political Economy of Health framework guides interpretation. Geographically weighted regression models show significant, local-level variation indicating that area-level factors drive patterns of HIV above individual-level contributions. In distinct locations, women who live further from health clinics, major roads, and major cities are less likely to be infected. For men, HIV status is strongly associated with migration patterns in specific areas. Local-level, gender-specific approaches to HIV prevention are necessary in high risk areas
Contraceptive use and pregnancy rates among women receiving antiretroviral therapy in Malawi: a retrospective cohort study
No full textAbstract Background In 2011, family planning (FP) services were integrated at Martin Preuss Centre (MPC), in urban Lilongwe, Malawi. To date, no previous study evaluated pregnancy rates among HIV-positive women after the integration of FP services into HIV care at the facility. In this study, we investigated whether integration of FP services into HIV clinical care led to increased use of contraceptives and decreased pregnancy rates. Methods This was a retrospective cohort analysis of HIV-positive women from 15 to 49 years of age who accessed antiretroviral therapy (ART) services at MPC. Ascertainment of FP needs, contraceptive methods and pregnancy status were done at ART initiation, and at each ART follow-up visit. Women were offered a wide range of contraceptive methods. Outcomes of interest were contraceptive use and rate of pregnancy. Incident pregnancy was ascertained through patient self-reports during clinic consultation. Trends of contraceptive use and pregnancy rates were analyzed using chi-square (χ2). Results A total of 10,472 women were included in the analysis and contributed 15,700 person-years of observation. Contraceptive use among all women receiving ART increased from 28% in 2012 to 62% in 2016 (p < 0.001). A total of 501 pregnancies occurred, including 13 multiple pregnancies, resulting in an overall pregnancy rates of 3.2 per 100 person-years. Rates of pregnancy decreased from 6.8 per 100 person-years in 2012 to 1.3 per 100 person-years in 2016 (p < 0.001). Conclusion Integration of FP services into HIV care resulted in increased contraceptive use and, subsequently, decreased pregnancy rates in women receiving ART. HIV programs should consider offering FP services to women who are receiving ART
It’s not just who you are but where you live: An exploration of community influences on individual HIV status in rural Malawi
No full textHum Resour Health
No full textBackgroundMozambique suffers from critical shortages of healthcare workers including non-physician clinicians, Tecnicos de Medicina Geral (TMGs), who are often senior clinicians in rural health centres. The Mozambique Ministry of Health and the International Training and Education Center for Health, University of Washington, Seattle, revised the national curriculum to improve TMG clinical knowledge and skills. To evaluate the effort, data was collected at graduation and 10\ua0months later from pre-revision (initial) and revised curriculum TMGs to determine the following: (1) Did cohorts trained in the revised curriculum score higher on measurements of clinical knowledge, physical exam procedures, and solving clinical case scenarios than those trained in the initial curriculum; (2) Did TMGs in both curricula retain their knowledge over time (from baseline to follow-up); and (3) Did skills and knowledge retention differ over time by curricula? Post-graduation and over time results are presented.Methodst-tests examine differences in scores between curriculum groups. Univariate and multivariate linear regression models assess curriculum-related, demographic, and workplace factors associated with scores on each of three evaluation methods at the p\u2009<\u20090.05 level. Paired t-tests examine within-group changes over time. ANOVA models explore differences between Health Training Institutes (HTIs). Generalized estimating equations determine whether change in scores over time differed by curricula.ResultsMean scores of initial curriculum TMGs at follow-up were 52.7%, 62.6%, and 40.0% on the clinical cases, knowledge test, and physical exam, respectively. Averages were significantly higher among the revised group for clinical cases (60.2%; p\u2009<\u20090.001) and physical exam (47.6%; p\u2009<\u20090.001). HTI was influential on clinical case and physical exam scores. Between graduation and follow-up, clinical case and physical exam scores decreased significantly for initial curriculum students; clinical case scores increased significantly among revised curriculum TMGs.ConclusionsAlthough curriculum revision had limited effect, marginal improvements in the revised group show promise that these TMGs may have increased ability to synthesize clinical information. Weaknesses in curriculum and practicum implementation likely compromised the effect of curriculum revision. An improvement strategy that includes strengthened TMG training, greater attention to pre-service clinical practice, and post-graduation mentoring may be more advantageous than curriculum revision, alone, to improve care provided by TMGs.20152015-04-16T00:00:00Z25884825PMC4404676677
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