22 research outputs found
Prev Sci
No full textIn sub-Saharan Africa, the prevalence of depressive symptoms among people living with HIV (PLHIV) is considerably greater than that among members of the general population. It is particularly important to treat depressive symptoms among PLHIV because they have been associated with poorer HIV care-related outcomes. This study describes overall psychosocial functioning and factors associated with depressive symptoms among PLHIV attending HIV care and treatment clinics in Kenya, Namibia, and Tanzania. Eighteen HIV care and treatment clinics (six per country) enrolled approximately 200 HIV-positive patients (for a total of 3,538 participants) and collected data on patients' physical and mental well-being, medical/health status, and psychosocial functioning. Although the majority of participants did not report clinically significant depressive symptoms (72\ua0%), 28\ua0% reported mild to severe depressive symptoms, with 12\ua0% reporting severe depressive symptoms. Regression models indicated that greater levels of depressive symptoms were associated with: (1) being female, (2) younger age, (3) not being completely adherent to HIV medications, (4) likely dependence on alcohol, (5) disclosure to three or more people (versus one person), (6) experiences of recent violence, (7) less social support, and (8) poorer physical functioning. Participants from Kenya and Namibia reported greater depressive symptoms than those from Tanzania. Approximately 28\ua0% of PLHIV reported clinically significant depressive symptoms. The scale-up of care and treatment services in sub-Saharan Africa provides an opportunity to address psychosocial and mental health needs for PLHIV as part of comprehensive care.CC999999/Intramural CDC HHS/United StatesPEPFAR/United State
BMC Public Health
No full textBackgroundTo evaluate the on-going scale-up of HIV programs, we assessed trends in patient characteristics at enrolment and ART initiation over 7\ua0years of implementation.MethodsData were from Optimal Models, a prospective open cohort study of HIV-infected (HIV+) adults ( 6515\ua0years) and children (<15\ua0years) enrolled from January 2005 to December 2011 at 44 HIV clinics in 3 regions of mainland Tanzania (Kagera, Kigoma, Pwani) and Zanzibar. Comparative statistics for trends in characteristics of patients enrolled in 2005\u20132007, 2008\u20132009 and 2010\u20132011 were examined.ResultsOverall 62,801 HIV\u2009+\u2009patients were enrolled: 58,102(92.5%) adults, (66.5% female); 4,699(7.5%) children.ConclusionsOver time, the proportion of pregnant women and of adults and children enrolled from PMTCT programs increased. There was a decline in adults and children with advanced HIV disease at enrolment and initiation of stavudine. Pediatric age at enrolment and ART initiation declined. Results suggest HIV program maturation from an emergency response.20135U2GPS001537/PHS HHS/United States5U62PS223540/PS/NCHHSTP CDC HHS/United States24160907PMC39372351063
A PPBS or cost analysis of the operation of Notre Dame of Midsayap (for girls) Midsayap, North Cotabato for the school year 1976-\u2777
No full textv. 1. This study applied the PPBS (Planning-Programming-Budgeting-Systems) cost analysis of Dr. Victor Ordonez in Educational Management-Finance and Control, to the high school program of Notre Dame of Midsayap, North Cotabato for the school year 1976-77. It brought out in exact figures, the cost incurred by the school per year level program for every student. Two steps were undertaken in this analysis. First, the traditional Statement of Income and Expenses was translated into a program budget. Primary and support activity centers were identified. Second. the development of a workload matrix whose coefficients became the basis in allocating and prorating the revenues and expenditures of the school. The study concluded that the PPBS can be applied in Secondary Course program.
v. 2. Data and information for the proposed faculty handbook for Mount Carmel School were gathered from former administrators, old and new faculties, students and school personnel whether still employed or retired. School records were examined and analyzed. Also, existing school policies and relevant practices were gathered for inclusion. The study, however, gave more emphasis on the interview method. This proposed Faculty Handbook contained the Philosophy and objectives of Mount Carmel School, organizational relationship and qualifications of various administrative officials, faculty and staff to set a guideline as to the different services offered by the school and how they should be carried out. Vital policies, procedures, rules and regulations contained therein were intended to serve as guides to direct their activities in promoting the welfare of the student body and the attainment of the school\u27s specific commitments. They were also meant to be instruments of unity and charity within the school, and for consistency in decision making. In school year 1977-78, this Proposed Faculty Handbook was presented to the faculty and Administration for discussion and comments and for possible revision of parts.
v. 3. This case study trains students to develop keenness and depth in studying behavioral problems of students so as to avoid greater problems or conflicts. In this case, the School Directress Sister Redempta is in a dilemma of whether to dismiss Romeo Ventanilla or let him continue his studies as pleaded by the Superior, Mother Michaela. The long list of misconducts of Romeo had to be given due punishment to bolster the morale of the school. Sister Redempta\u27s firm decision incited Mother Michaela to use her power to plead for the boy\u27s retention. Alternatives presented were : 1. Romeo stays, Sister Redempta leaves. Consequences: a. Romeo, knowing that somebody worked out his retention and aware his family is very influential in school, may totally ruin him in the future. b. undermine the students\u27 welfare in school. c. Sister Redempta\u27s departure may affect her vocation and the school community may be left to unfavorable conclusions for sacrificing the Sister to the boy. 2. Sister Redempta stays, Romeo steps out. Consequences: a. The status of the administrator is maintained. b. The morale of the school is maintained. c. Romeo loses one school year. d. His dismissal may ruin his life. 3. Sister Redempta remains, Romeo ends up his classes. Consequences: a. Both parties remain in their status. b. Both will not feel frustrated. c. Ill feelings of the Ventanilla\u27s towards the school is not aggravated. d. Mother Michaela\u27s wish is half way met. The author\u27s recommendation is to advise Romeo to leave the school unnoticed by the student body but he be promoted so as not to lose one school year
"Who are you?": Identifying Young Users from a Single Search Query
No full textAs an initial step towards enabling the adaptation of (popular, and widely used) web search environments so that they can better serve children and ease their path towards information discovery, we introduce Recognizing Young Searchers (RYSe). RYSe leverages lexical, syntactical, spelling/punctuation, and vocabulary features that align with the Concrete Operational stage of development (originally identified by Jean Piaget) in an attempt to identify users that are in this stage. The concrete operational stage is commonly associated with children ages 7-11. Findings emerging from our initial empirical exploration using single queries formulated by children and sample queries from adults showcase the feasibility of relying on different cognitive traits inferred from the short text of a single query to distinguish those that are formulated by younger searchers. Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Web Information System
Can investment in quality drive use? A cluster-randomised controlled study in rural Tanzania
No full textBackground: Reduction in maternal and neonatal mortality requires women's use of high-quality facilities for childbirth. Evidence that quality influences women's selection of place of delivery suggests that an investment in quality may increase use of facilities for childbirth. We assessed the impact of a quality improvement project on facility use for childbirth among women in Tanzania.
Methods: Of 24 government-managed primary care clinics in Pwani Region, Tanzania, we randomly selected 12 to receive an intervention consisting of: training, supportive supervision, infrastructure support, and peer outreach. The cluster was defined as the health clinic and the villages assigned to its catchment area by the ward. We collected household surveys of women living within the catchment area of each clinic with a birth in the past year at baseline (February–April 2012) and endline (January–April 2016). Women reported the location of birth for each of their deliveries, including the facility name. The primary outcome was report of facility use for childbirth for their most recent birth. The effect of the intervention was assessed using difference-in-difference analysis. We conducted an exploratory secondary analysis among women least likely to use the health system—ie, those whose prior delivery was a home birth. We investigated three pathways from the intervention to increased facility use: improved obstetric quality, improved antenatal care (ANC) quality, and improved links between the health system and the community.
Findings: In the intervention clusters, 999 (71·7%) of 1393 women gave birth in a facility at baseline and 1165 (85·3%) of 1365 did so at endline. The corresponding figures for the control clusters were 1146 (72·3%) of 1586 at baseline and 1411 (81·1%) of 1739 at endline. The intervention thus led to an increase in facility births of 6·7 percentage points (95% CI 0·6–12·8). The intervention was substantially more successful in increasing use among women least likely to utilise the health system, giving a 18·3 percentage point increase (95% CI 10·1–26·6). Among the hypothesised mechanisms, the most likely pathway of effect was through ANC: the intervention led to an increase in ANC quality, with providers performing an additional 0·8 (95% CI 0·21–1·34) actions among the low-use population and 0·5 actions among the full population (95% CI −0·01 to 1·01).
Interpretation: The quality improvement intervention led to a modest increase in facility use for childbirth and a strong increase among women whose previous delivery was at home. Our analysis provides empirical evidence that investment in quality can increase health care use. In an environment of rising use, quality may be a mechanism for encouraging remaining non-system users to engage in the health system, playing a role in achieving universal health coverage.
Funding: US National Institutes of Health 1R01AI093182
Missed Opportunities to Improve the Health of Postpartum Women: High Rates of Untreated Hypertension in Rural Tanzania
No full textObjectives To assess the prevalence of high blood pressure amongst postpartum women in rural Tanzania, and to explore factors associated with hypertension prevalence, awareness, treatment, and control. Methods 1849 women in Tanzania’s Pwani Region who delivered a child in the prior year participated in the study. We measured blood pressure, administered a structured questionnaire and assessed factors associated with the prevalence, awareness, treatment, and control of hypertension (HTN) using bivariable and multivariable logistic regressions. Findings 26.7% of women had high blood pressure and/or were taking antihypertensive medication. Women were on average 27.5 years old (range 15–54). Nearly all women (99.5%) reported contact with the health system during their pregnancy and delivery, with an average of 5.2 visits for their own care in the past year. Only 23.5% of those with HTN were aware of their diagnosis, 17.4% were taking medication, and only 10.5% had controlled blood pressure. In multivariable analysis, facility delivery, health insurance, and increased distance from a hospital were associated with increased likelihood of HTN awareness; facility delivery and hospital distance were associated with current hypertensive treatment; younger age and increased hospital distance were associated with control of HTN. Conclusion The prevalence of high blood pressure in this postpartum population was high, and despite frequent recent contacts with the health system, awareness, treatment and control of HTN were low. These findings highlight an important missed opportunity to improve women’s health during antenatal and postnatal care
Basic Accountability to Stop Ill-Treatment (BASI); Study Protocol for a Cluster Randomized Controlled Trial in Rural Tanzania
No full textBackground: Poor health system experiences negatively affect the lives of poor people throughout the world. In East Africa, there is a growing body of evidence of poor quality care that in some cases is so poor that it is disrespectful or abusive. This study will assess whether community feedback through report cards (with and without non-financial rewards) can improve patient experience, which includes aspects of patient dignity, autonomy, confidentiality, communication, timely attention, quality of basic amenities, and social support.Methods/Design: This cluster-randomized controlled study will randomize 75 primary health care facilities in rural Pwani Region, Tanzania to one of three arms: private feedback (intervention), social recognition reward through public reporting (intervention), or no feedback (control). Within both intervention arms, we will give the providers at the study facilities feedback on the quality of patient experience the facility provides (aggregate results from all providers) using data from patient surveys. The quality indicators that we report will address specific experiences, be observable by patients, fall into well-identified domains of patient experience, and be within the realm of action by healthcare providers. For example, we will measure the proportion of patients who report that providers definitely “explained things in a way that was easy to understand.” This feedback will be delivered by a medical doctor to all the providers at the facility in a small group session. A formal discussion guide will be used. Facilities randomized to the social recognition intervention reward arm will have two additional opportunities for social recognition. First, a poster that displays their achieved level of patient experience will be publicly posted at the health facility and village government offices. Second, recognition from senior officials at the local NGO and/or the Ministry of Health will be given to the facility with the best or most-improved patient experience ratings at endline. We will use surveys with parents/guardians of sick children to measure patient experience, and surveys with healthcare providers to assess potential mechanisms of effect.Conclusion: Results from this study will provide evidence for whether, and through what mechanisms, patient reported feedback can affect interpersonal quality of care.Pan African Clinical Trials Registry (PACTR): 201710002649121 Protocol version 7, November 8, 201
Reviewing progress: 7 Year Trends in Characteristics of Adults and Children Enrolled at HIV Care and Treatment Clinics in the United Republic of Tanzania.
No full textTo evaluate the on-going scale-up of HIV programs, we assessed trends in patient characteristics at enrolment and ART initiation over 7 years of implementation. Data were from Optimal Models, a prospective open cohort study of HIV-infected (HIV+) adults (>=15 years) and children (<15 years) enrolled from January 2005 to December 2011 at 44 HIV clinics in 3 regions of mainland Tanzania (Kagera, Kigoma, Pwani) and Zanzibar. Comparative statistics for trends in characteristics of patients enrolled in 2005--2007, 2008--2009 and 2010--2011 were examined. Overall 62,801 HIV+ patients were enrolled: 58,102(92.5%) adults, (66.5% female); 4,699(7.5%) children.Among adults, pregnant women enrolment increased: 6.8%, 2005--2007; 12.1%, 2008--2009; 17.2%, 2010--2011; as did entry into care from prevention of mother-to-child HIV transmission (PMTCT) programs: 6.6%, 2005--2007; 9.5%, 2008--2009; 12.6%, 2010--2011. WHO stage IV at enrolment declined: 27.1%, 2005--2007; 20.2%, 2008--2009; 11.1% 2010--2011. Of the 42.5% and 29.5% with CD4+ data at enrolment and ART initiation respectively, median CD4+ count increased: 210cells/muL, 2005--2007; 262cells/muL, 2008--2009; 266cells/muL 2010--2011; but median CD4+ at ART initiation did not change (148cells/muL overall). Stavudine initiation declined: 84.9%, 2005--2007; 43.1%, 2008--2009; 19.7%, 2010--2011.Among children, median age (years) at enrolment decreased from 6.1(IQR:2.7-10.0) in 2005--2007 to 4.8(IQR:1.9-8.6) in 2008--2009, and 4.1(IQR:1.5-8.1) in 2010--2011 and children <24 months increased from 18.5% to 26.1% and 31.5% respectively. Entry from PMTCT was 7.0%, 2005--2007; 10.7%, 2008--2009; 15.0%, 2010--2011. WHO stage IV at enrolment declined from 22.9%, 2005--2007, to 18.3%, 2008--2009 to 13.9%, 2010--2011. Proportion initiating stavudine was 39.8% 2005--2007; 39.5%, 2008--2009; 26.1%, 2010--2011. Median age at ART initiation also declined significantly. Over time, the proportion of pregnant women and of adults and children enrolled from PMTCT programs increased. There was a decline in adults and children with advanced HIV disease at enrolment and initiation of stavudine. Pediatric age at enrolment and ART initiation declined. Results suggest HIV program maturation from an emergency response
Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster‐randomised study in rural Tanzania
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