1,721,052 research outputs found
An Investigation into Quality of Care at the Time of Birth at Public and Private Sector Maternity Facilities in Uttar Pradesh, India
Get PDFBackground: Ensuring high quality care during labour and childbirth is important to eliminate
preventable maternal deaths, neonatal deaths and intrapartum stillbirths. My PhD
investigates quality of care (QoC) during normal labour and childbirth, and examines whether
QoC is influenced by management practices at 26 public and private sector maternity facilities
in Uttar Pradesh, India.
Methods: First, I conducted clinical observations of labour and childbirth. I used descriptive
statistics and multivariate analysis techniques to describe and compare differences in overall
QoC, and quality for obstetric and neonatal care. Second, I used quantitative and qualitative
methods to describe existing patterns of mistreatment encountered by women. Third, I
described existing management practices using a separate survey dataset and linked both
QoC and management datasets to examine the relationship between management practices
and QoC.
Results: QoC was found to be poor at both public and private sector facilities. The private
sector outperformed public sector facilities for overall essential care at birth, and for both
obstetric and newborn care. All women encountered at least one indicator of mistreatment.
There were no significant differences between qualified and unqualified personnel for QoC
and mistreatment levels. Qualitative results suggest that informal payments are widespread,
maternity care pathways are non-functional, and there are poor hygiene standards. Lastly, I
found that maternity facilities scored poorly on management best practices. Overall, I found
no association between total management scores and QoC.
Conclusions: The results of my PhD study indicate that in 2015, in maternity facilities of Uttar
Pradesh, unqualified personnel provided the bulk of maternity care, adherence to evidencebased
obstetric and neonatal care protocols was generally poor and all women encountered
at least one practice of mistreatment. These results suggest the need to comprehensively
measure and urgently improve QoC at the time of birth in Uttar Pradesh, India
Equity of access to reproductive and maternal health services in Cambodia: equity trends, poverty targeting and demand-side financing
Get PDFHealth
inequities
are
a
serious
public
health
concern.
Achievements
in
health
equity
are
particularly
challenging
to
attain
in
reproductive
and
maternal
health
in
developing
countries.
Research
exploring
this
issue
is
of
great
relevance,
given
the
extent
of
such
disparities,
and
as
pressure
builds
to
include
universal
health
coverage
in
the
post-‐
2015
development
goals.
This
thesis
examines
equity
in
reproductive
and
maternal
health
services
in
Cambodia,
and
two
health
financing
interventions
aiming
to
improve
health
equity,
Vouchers
for
Reproductive
Health
Services
(VRHS)
and
Health
Equity
Funds
(HEFs).
Study
objective
1
was
to
estimate
equity
in
reproductive
and
maternal
health
services
in
Cambodia
over
the
last
decade.
Analysis
was
conducted
with
Demographic
and
Health
Survey
data
for
six
health
services
between
2000
and
2010,
revealing
that
dramatic
improvements
have
been
made
in
reproductive
and
maternal
health
equity
since
2000,
however
inequity
remains
in
use
of
facility-‐based
deliveries
and
skilled
birth
attendance.
Objective
2
was
to
qualitatively
explore
Cambodia’s
poverty
identification
programme,
the
ID
Poor.
Semi-‐structured
interviews
were
conducted
with
women,
service
providers
and
programme
implementers.
Extensive
targeting
errors
within
the
programme
were
found,
with
implications
for
the
targeting
effectiveness
of
VRHS
and
HEFs.
Objective
3
was
to
qualitatively
explore
low
uptake
of
vouchers
in
the
VRHS
project,
also
using
interview
data.
It
was
found
that
vouchers
were
positively
received
by
beneficiaries
and
had
the
potential
to
influence
health-‐seeking
behaviour.
However
several
factors
were
found
to
improve
future
voucher
performance.
Objective
4
assessed
the
impact
of
HEFs
on
financial
protection,
service
utilisation
and
health
outcomes,
using
difference-‐in-‐differences
analysis.
Evidence
of
a
financially
protective
effect
of
HEFs
was
found;
no
effect
was
found
for
service
use
or
health
outcomes.
The
thesis
contributes
to
knowledge
gaps
in
the
health
equity,
poverty
targeting
and
demand-‐side
financing
literature,
and
provides
practical
policy
implications
based
on
empirical finding
Investigating the quality of primary health care: the determinants of doctor provision of care and clinical behaviour in Tunisia
No full textWhile access to primary health care services has improved through expansions of the public and private sector, quality of care remains a pressing issue in the Middle East and North Africa region. This thesis focuses on Tunisia, where there have been reports of challenges in the availability of qualified health workers and essential medicines. However, there is less evidence on the clinical quality of care, which is more difficult to monitor and regulate.
This thesis investigates the quality of care provided by general practitioners (GPs) and its determinants in Tunisia. To measure quality, I use undercover standardised patient visits and clinical vignettes carried out between November 2017 and June 2018 from a representative sample of 177 public and 79 private GPs in the urban ‘Grand Tunis’ region of Tunisia. These data were combined with information from a GP survey data on provider characteristics.
The thesis includes three research papers. In the first one, I evaluate doctor clinical knowledge and investigate its determinants, with a key focus on differences between public and private doctors. I find that clinical knowledge was suboptimal, with wide variation across clinical cases and lower knowledge in the private sector. The place of initial medical education was a strong predictor of clinical knowledge. In the second paper, I examine antibiotic prescribing behaviour and the role of the patient through an experimental audit study involving standardised patients. Overprescribing rates were strikingly high, with prescribing behaviour significantly worse in the private sector. The majority of the drugs prescribed were unnecessary or potentially harmful and generated high levels of waste of patients’ resources. There was limited evidence that provider behaviour was influenced by standardised patients requesting antibiotics or expressing knowledge of inappropriate prescribing. In the third paper, I explore whether doctors discriminate according to patient socioeconomic status (SES). I find no evidence of SES-based discrimination in the provision of care to standardised patients. If anything, I find that doctors prescribed less expensive medicines and gave significantly more (and more unnecessary) free-of-charge medicines to poorer patient. However, doctor communication was worse when patients were poor than when they appeared well off.
Overall, these results suggest that doctors play a crucial role in driving the quality of primary health care in urban Tunisia. This quality of care appears to vary in some respects with the socioeconomic background of the patient. Further, there is widespread overprovision of antibiotics in both the public and private sector, but doctors’ behaviour does not appear to be influenced by the patient. With these findings, I consider the policy implications and future avenues for further research
Democracy and growth in divided societies: A health-inequality trap?
No full textDespite a tremendous increase in financial resources, many countries are not on track to achieve the child and maternal mortality targets set out in the Millennium Development Goals 4 and 5. It is commonly argued that two main social factors - improved democratic governance and aggregate income - will ultimately lead to progress in reducing child and maternal mortality. However, these two factors alone may be insufficient to achieve progress in settings where there is a high level of social division. To test the effects of growth and democratisation, and their interaction with social inequalities, we regressed data on child and maternal mortality rates for 192 countries against internationally used indexes of income, democracy, and population inequality (including income, ethnic, linguistic, and religious divisions) covering the period 1970-2007. We found that a higher degree of social division, especially ethnic and linguistic fractionalisation, was significantly associated with greater child and maternal mortality rates. We further found that, even in democratic states, greater social division was associated with lower overall population access to healthcare and lesser expansion of health system infrastructure. Perversely, while greater democratisation and aggregate income were associated with reduced maternal and child mortality overall, in regions with high levels of ethnic fragmentation the health benefits of democratisation and rising income were undermined and, at high levels of inequality reversed, so that democracy and growth were adversely related to child and maternal mortality. These findings are consistent with literature suggesting that high degrees of social division in the context of democratisation can strengthen the power of dominant elite and ethnic groups in political decision-making, resulting in health and welfare policies that deprive minority groups (a health-inequality trap). Thus, we show that improving economic growth and democratic governance are insufficient to achieve child and maternal health targets in communities with high levels of persistent social inequality. To reduce child and maternal mortality in highly divided societies, it will be necessary not only to increase growth and promote democratic elections, but also empower disenfranchised communities
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
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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