| 11. |
- Källestål, Carina, 1954-, et al.
(author)
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Predicting poverty : data mining approaches to the health and demographic surveillance system in Cuatro Santos, Nicaragua
- 2019
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In: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 18:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: In order to further identify the needed interventions for continued poverty reduction in our study area Cuatro Santos, northern Nicaragua, we aimed to elucidate what predicts poverty, measured by the Unsatisfied Basic Need index. This analysis was done by using decision tree methodology applied to the Cuatro Santos health and demographic surveillance databases.METHODS: Using variables derived from the health and demographic surveillance update 2014, transferring individual data to the household level we used the decision tree framework Conditional Inference trees to predict the outcome "poverty" defined as two to four unsatisfied basic needs using the Unsatisfied Basic Need Index. We further validated the trees by applying Conditional random forest analyses in order to assess and rank the importance of predictors about their ability to explain the variation of the outcome "poverty." The majority of the Cuatro Santos households provided information and the included variables measured housing conditions, assets, and demographic experiences since the last update (5 yrs), earlier participation in interventions and food security during the last 4 weeks.RESULTS: Poverty was rare in households that have some assets and someone in the household that has a higher education than primary school. For these households participating in the intervention that installed piped water with water meter was most important, but also when excluding this variable, the resulting tree showed the same results. When assets were not taken into consideration, the importance of education was pronounced as a predictor for welfare. The results were further strengthened by the validation using Conditional random forest modeling showing the same variables being important as predicting the outcome in the CI tree analysis. As assets can be a result, rather than a predictor of more affluence our results in summary point specifically to the importance of education and participation in the water installation intervention as predictors for more affluence.CONCLUSION: Predictors of poverty are useful for directing interventions and in the Cuatro Santos area education seems most important to prioritize. Hopefully, the lessons learned can continue to develop the Cuatro Santos communities as well as development in similar poor rural settings around the world.
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| 12. |
- Massri, Camila, et al.
(author)
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Impact of the Food-Labeling and Advertising Law Banning Competitive Food and Beverages in Chilean Public Schools, 2014-2016
- 2019
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In: American Journal of Public Health. - : AMER PUBLIC HEALTH ASSOC INC. - 0090-0036 .- 1541-0048. ; 109:9, s. 1249-1254
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Journal article (peer-reviewed)abstract
- Objectives. To evaluate the impact of a national law banning sales of competitive food and beverages (CF&B) in schools on the availability of CF&B sold at school kiosks. Methods. This study was uncontrolled before and after study. We evaluated public schools in Santiago de Chile (n = 21; 78% response rate) in 2014 and 2016 (6 months after the law came into force). Trained personnel collected data on calories, total sugars, saturated fat, and sodium from food labels. The outcome was the percentage of foods exceeding the cutoff levels defined in the law and the mean difference between 2014 and 2016. Results. Foods exceeding any cutoffs decreased from 90.4% in 2014 to 15.0% in 2016. Solid products had a substantial reduction in calories, sugar, saturated fat, and sodium. Liquid products had a reduction in calories, total sugar, and saturated fat, whereas sodium increased. This was a result of changes in product mix. Conclusions. A ban on sales of CF&B reduced the availability of CF&B at Santiago's school kiosks. Further research should examine the impact of this ban on food intake and health outcomes.
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| 13. |
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| 14. |
- Mohammadi, Soheila, et al.
(author)
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Clinical Audits : A pratical strategy for reducing cesarean section rates in a general hospital in Tehran, Iran
- 2012
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In: Journal of reproductive medicine. - 0024-7758 .- 1943-3565. ; 57:1-2, s. 43-48
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate whether the introduction of clinical audits by the Safe Motherhood Committee of a general hospital in Tehran, Iran, influenced cesarean section (CS) rates. STUDY DESIGN: A retrospective study was performed. The number of deliveries before and after the institution of clinical audits (May to December 2005) were tabulated in the audited hospital and analyzed by c2 test. Additionally, CS rates were measured in 3 other general hospitals during the same time period for comparison. RESULTS: A total of 3,494 deliveries were recorded during the study periods in 2004 and 2005 at the audited hospital. Subsequent to the audit, the overall CS rate decreased from 40% to 33% (p<0.001) and the primary CS rate from 29% to 21% (p<0.001), accounting for a 27% reduction in the risk of primary CS. In 2006 CS rates reverted to 42%. None of the other 3 general hospitals indicated a decline in CS rates in 2005. CONCLUSION: Our findings show a preventive association between the clinical audits and CS rates in a general hospital. The implementation of a clinical audit process can be an effective way to track care pathways and reduce unnecessary CS deliveries.
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| 15. |
- Mohammadi, Soheila, 1967-, et al.
(author)
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Maternal near-miss at university hospitals with cesarean overuse : an incident case-control study
- 2016
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 95:7, s. 777-786
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Cesarean section (CS) carries a substantial risk of maternal near-miss (MNM) morbidity. This study aimed at determining the frequency, causes, risk factors, and perinatal outcomes of MNM at three university hospitals with a high rate of CS in Tehran, Iran.MATERIAL AND METHODS: An incident case-control study was conducted from March 2012 to May 2014. The modified WHO near-miss criteria were used to identify cases. A control sample of 1024 women delivering at the study hospitals was recruited to represent the source population. Near-miss ratio, crude and adjusted odds ratios (aORs) with confidence intervals (CI) were assessed.RESULTS: Among 12 965 live births, 82 mothers developed near-miss morbidities and 12 died. The MNM ratio was 6.3/1000 live births. Severe postpartum hemorrhage (35%, 29/82), severe pre-eclampsia (32%, 26/82), and placenta previa/abnormally invasive placenta (10%, 8/82) were the most frequent causes of MNM. Women with antepartum CS (aOR 7.4, 95%CI 3.7-15.1) and co-morbidity (aOR 2.3, 95%CI 1.4-3.8), uninsured Iranians (aOR 3.4, 95%CI 1.7-7.1) and uninsured Afghans (aOR 4.7, 95%CI 2.4-9.2) had increased risks of near-miss morbidity. Stillbirth and extremely preterm birth were the most prominent adverse perinatal outcomes associated with MNM.CONCLUSION: Overutilization of CS clearly influenced the causes of MNM. A lack of health insurance had a measurable impact on near-miss morbidity. Tailored interventions for reducing unnecessary CS and unrestricted insurance cover for emergency obstetric care can potentially improve maternal and perinatal outcomes. This article is protected by copyright. All rights reserved.
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| 16. |
- Pallangyo, Eunice N., et al.
(author)
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A baseline mixed methods study on postpartum care among health professionals in Tanzania
- 2017
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In: African Journal of Midwifery and Women's Health. - 1759-7374 .- 2052-4293. ; 11:3, s. 115-122
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Journal article (peer-reviewed)abstract
- Background: Globally, postpartum care (PPC) is a neglected part of maternal and neonatal health, despite 50% of maternal deaths occuring in the first weeks after childbirth.Aim: The study aimed to assess knowledge, attitudes and practices among providers of PPC in government institutions in two low-resource suburbs of Dar es Salaam: Ilala and Temeke.Methods: Health professionals ( n =149) at all levels of care completed a knowledge and attitudes questionnaire. A checklist was used to observe 25 health professionals at reproductive and child health units, and 38 mothers were interviewed on exit. χ 2 - and logistic regression tests were used to analyse the outcomes. Field notes were analysed qualitatively.Findings: Overall, 64% of health professionals had high knowledge and most had positive attitudes towards PPC. Level of education was found to be positively associated with positive attitudes towards PPC (OR=2.5 CI 95% 1.03–6.13). PPC consultations with mothers and newborns during the first week after childbirth were found to be few or nonexistent. Mothers who came with newborns for BCG immunisation were mostly satisfied with the services.Conclusion: Quality improvement is required at the structure and process levels of the health system in order to provide holistic PPC consultations.
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| 17. |
- Pallangyo, Eunice N., et al.
(author)
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Improved postpartum care after a participatory facilitation intervention in Dar es Salaam, Tanzania : a mixed method evaluation
- 2017
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In: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10:1
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Journal article (peer-reviewed)abstract
- BACKGROUND:In order to improve the health and survival of mothers/newborns, the quality and attendance rates of postpartum care (PPC) must be increased, particularly in low-resource settings.OBJECTIVE:To describe outcomes of a collegial facilitation intervention to improve PPC in government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania.METHODS:A before-and-after evaluation of an intervention and comparison group was conducted using mixed methods (focus group discussions, questionnaires, observations, interviews, and field-notes) at health institutions. Maternal and child health aiders, enrolled nurse midwives, registered nurse midwives, and medical and clinical officers participated. A collegial facilitation intervention was conducted and healthcare providers were organized in teams to improve PPC at their workplaces. Facilitators defined areas of improvement with colleagues and met regularly with a supervisor for support.RESULTS:The number of mothers visiting the institution for PPC increased in the intervention group. Some care actions were noted in more than 80% of the observations and mothers reported high satisfaction with care. In the comparison group, PPC continued to be next to non-existent. The healthcare providers' knowledge increased in both groups but was higher in the intervention group. The t-test showed a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference of differences for knowledge was 1.3. The providers perceived the intervention outcomes to include growing professional confidence/knowledge, improved PPC quality, and mothers' positive response. The quality grading was based on the national guidelines and involved nine experts and showed that none of the providers reached the level of good quality of care.CONCLUSIONS:The participatory facilitation intervention contributed to improved quality of PPC, healthcare providers' knowledge and professional confidence, awareness of PPC among mothers, and increased PPC attendance.
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| 18. |
- Pérez, Wilton, 1979-, et al.
(author)
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Comparing progress toward the child mortality Millennium Development Goal in León and Cuatro Santos, Nicaragua, 1990–2008
- 2014
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In: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 14, s. 9-
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Journal article (peer-reviewed)abstract
- Background: Social inequality in child survival hampers the achievement of Millennium Development Goal 4 (MDG4). Monitoring under-five mortality in different social strata may contribute to public health policies that strive to reduce social inequalities. This population-based study examines the trends, causes, and social inequality of mortality before the age of five years in rural and urban areas in Nicaragua. Methods: The study was conducted in one rural (Cuatro Santos) and one urban/rural area (Leon) based on data from Health and Demographic Surveillance Systems. We analyzed live births from 1990 to 2005 in the urban/rural area and from 1990 to 2008 in the rural area. The annual average rate reduction (AARR) and social under-five mortality inequality were calculated using the education level of the mother as a proxy for socio-economic position. Causes of child death were based on systematic interviews (verbal autopsy). Results: Under-five mortality in all areas is declining at a rate sufficient to achieve MDG4 by 2015. Urban Leon showed greater reduction (AARR = 8.5%) in mortality and inequality than rural Leon (AARR = 4.5%) or Cuatro Santos (AARR = 5.4%). Social inequality in mortality had increased in rural Leon and no improvement in survival was observed among mothers who had not completed primary school. However, the poor and remote rural area Cuatro Santos was on track to reach MDG4 with equitable child survival. Most of the deaths in both areas were due to neonatal conditions and infectious diseases. Conclusions: All rural and urban areas in Nicaragua included in this study were on track to reach MDG4, but social stratification in child survival showed different patterns; unfavorable patterns with increasing inequity in the peri-urban rural zone and a more equitable development in the urban as well as the poor and remote rural area. An equitable progress in child survival may also be accelerated in very poor settings.
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| 19. |
- Pérez, Wilton, 1979-, et al.
(author)
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Food insecurity and self-rated health in rural Nicaraguan women of reproductive age : a cross-sectional study
- 2018
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In: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 17:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Access to food is a basic necessity, and food insecurity may impair the individual's well-being and health. Self-rated health measurements have frequently been used to assess population health. Little is known, however, as to whether food security is associated with self-rated health in low- and middle-income settings. This study aims at analyzing the association between food security and self-rated health among non-pregnant women of reproductive age in a rural Nicaraguan setting.METHODS: Data was taken from the 2014 update of a health and demographic surveillance system in the municipalities of Los Cuatro Santos in northwestern Nicaragua. Fieldworkers interviewed women about their self-rated health using a 5-point Likert scale. Food insecurity was assessed by the household food insecurity access (HFIAS) scale. A multilevel Poisson random-intercept model was used to calculate the prevalence ratio.RESULTS: The survey included 5866 women. In total, 89% were food insecure, and 48% had poor self-rated health. Food insecurity was associated with poor self-rated health, and remained so after adjustment for potential confounders and accounting for community dependency.CONCLUSION: In this Nicaraguan resource-limited setting, there was an association between food insecurity and poor self-rated health. Food insecurity is a facet of poverty and measures an important missing capability directly related to health.
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| 20. |
- Perez, Wilton, 1979-, et al.
(author)
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Progress towards millennium development goal 1 in northern rural Nicaragua : Findings from a health and demographic surveillance site
- 2012
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In: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 11:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND:Millennium Development Goal 1 encourages local initiatives for the eradication of extreme poverty. However, monitoring is indispensable to insure that actions performed at higher policy levels attain success. Poverty in rural areas in low- and middle-income countries remains chronic. Nevertheless, a rural area (Cuatro Santos) in northern Nicaragua has made substantial progress toward poverty eradication by 2015. We examined the level of poverty there and described interventions aimed at reducing it.METHODS:Household data collected from a Health and Demographic Surveillance System was used to analyze poverty and the transition out of it, as well as background information on family members. In the follow-up, information about specific interventions (i.e., installation of piped drinking water, latrines, access to microcredit, home gardening, and technical education) linked them to the demographic data. A propensity score was used to measure the association between the interventions and the resulting transition from poverty.RESULTS: Between 2004 and 2009, poverty was reduced as a number of interventions increased. Although microcredit was inequitably distributed across the population, combined with home gardening and technical training, it resulted in significant poverty reduction in this rural area.CONCLUSIONS:Sustainable interventions reduced poverty in the rural areas studied by about one- third.
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