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Improving Maternal Survival in South Asia—What Can We Learn from Case Studies?
No full textTechnical interventions for maternal healthcare are implemented through
a dynamic social process. Peoples' behaviours—whether they be
planners, managers, providers, or potential users—influence the
outcomes. Given the complexity and unpredictability inherent in such
dynamic processes, the proposed cause-and-effect relationships in any
one context cannot be directly transferred to another. While this is
true of all health services, its importance is magnified in maternal
healthcare because of the need to involve multiple levels of the health
system, multiple types of care providers from the highly skilled
specialist to community-level volunteers, and multiple technical
interventions, without the ability to measure significant change in the
outcome, the maternal mortality ratio. Patterns can be followed
however, in terms of outcomes in response to interventions. From these
case studies of implementation of maternal health programmes across
five states of India, Pakistan, and Bangladesh, some patterns stand out
and seem to apply virtually everywhere (e.g. failure of systems to post
staff in difficult areas) while others require more data to understand
the observed patterns (e.g. response to financial incentives for
improving maternal health systems; instituting available accessible
safe blood). The patterns formed can provide guidance to programme
managers as to what aspects of the process to track and micro-manage,
to policy-makers as to what features of a context may particularly
influence impacts of alternative maternal health strategies, and to
governments more broadly as to the factors shaping dynamic responses
that might themselves warrant intervention
Going to scale with professional skilled care
No full textBecause most women prefer professionally provided maternity care when they have access to it, and since the needed clinical interventions are well known, we discuss in their paper what is needed to move forward from apparent global stagnation in provision and use of maternal health care where maternal mortality is high. The main obstacles to the expansion of care are the dire scarcity of skilled providers and health-system infrastructure, substandard quality of care, and women's reluctance to use maternity care where there are high costs and poorly attuned services. To increase the supply of professional skilled birthing care, strategic decisions must be made in three areas: training, deployment, and retention of health workers. Based on results from simulations, teams of midwives and midwife assistants working in facilities could increase coverage of maternity care by up to 40% by 2015. Teams of providers are the efficient option, creating the possibility of scaling up as much as 10 times more quickly than would be the case with deployment of solo health workers in home deliveries with dedicated or multipurpose worker
Improving Maternal Survival in South Asia\u2014What Can We Learn from Case Studies?
No full textTechnical interventions for maternal healthcare are implemented through
a dynamic social process. Peoples' behaviours\u2014whether they be
planners, managers, providers, or potential users\u2014influence the
outcomes. Given the complexity and unpredictability inherent in such
dynamic processes, the proposed cause-and-effect relationships in any
one context cannot be directly transferred to another. While this is
true of all health services, its importance is magnified in maternal
healthcare because of the need to involve multiple levels of the health
system, multiple types of care providers from the highly skilled
specialist to community-level volunteers, and multiple technical
interventions, without the ability to measure significant change in the
outcome, the maternal mortality ratio. Patterns can be followed
however, in terms of outcomes in response to interventions. From these
case studies of implementation of maternal health programmes across
five states of India, Pakistan, and Bangladesh, some patterns stand out
and seem to apply virtually everywhere (e.g. failure of systems to post
staff in difficult areas) while others require more data to understand
the observed patterns (e.g. response to financial incentives for
improving maternal health systems; instituting available accessible
safe blood). The patterns formed can provide guidance to programme
managers as to what aspects of the process to track and micro-manage,
to policy-makers as to what features of a context may particularly
influence impacts of alternative maternal health strategies, and to
governments more broadly as to the factors shaping dynamic responses
that might themselves warrant intervention
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh
Get PDFAbstract Background Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). Conclusion The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.</p
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