| 1. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria : A secondary analysis of data from a cluster randomized controlled trial
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science. - 1932-6203. ; 13:12, s. 1-22
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Tidskriftsartikel (refereegranskat)abstract
- Background The burden of maternal and neonatal mortality remains persistently high in Nigeria. Sepsis contributes significantly to both maternal and newborn mortality, and safe delivery kits have long been promoted as a cost-effective intervention to ensure hygienic delivery practices and reduce sepsis. However, there is limited evidence on the effectiveness of home birth kit distribution by community health workers, and particularly the impact of this intervention on health outcomes. This paper reports a secondary analysis of data from a cluster randomized trial in rural northern Nigeria in which birth kits were distributed by community health workers to pregnant women in their homes, analyzing non-experimental variation in receipt and use of birth kits. More specifically, associations between pregnant women’s baseline characteristics and receipt and use of birth kits, and associations between birth kit use, care utilization and maternal and newborn outcomes were assessed. Methods and findings Baseline, post-birth and endline data related to 3,317 births observed over a period of three years in 72 intervention communities in Jigawa state, Nigeria, were analyzed using hierarchical, logistic regression models. In total, 140 women received birth kits, and 72 women used the kits. There were no associations between baseline demographic characteristics, health history, and knowledge and attitudes and receipt of a kit, suggesting that community health workers did not systematically target the distribution of birth kits. However, women who used the kit reported reduced odds of past pregnancy complications (OR = 0.44, 95% CI: 0.19-1.00) as well as significantly higher odds of feeling generally healthy at baseline (OR = 2.00, 95% CI: 1.06-3.76), of exposure to radio media (OR = 1.97, 95% CI: 1.21-3.22), and of perceiving themselves as having a low-risk pregnancy (OR = 3.05, 95% CI:1.39-6.68). While there were no significant associations between birth kit use and facility based delivery, skilled birth attendance or post-natal care, women who used a kit exhibited significantly lower odds of completing four or more ANC visits (adjusted OR = 0.39, 95% CI: 0.18-0.85) and significantly higher odds of reporting prolonged labor (adjusted OR = 4.75, 95% CI: 1.36-16.59), and post-partum bleeding (adjusted OR = 3.25, 95% CI: 1.11-9.52). Conclusions This evidence suggests that use of birth kits is low in a rural population characterized by minimal baseline utilization of maternal and neonatal health services, and the use of birth kits was not associated with reductions in maternal or neonatal morbidity. While further research is required to understand how the effectiveness of birth kits may be shaped by the mechanism through which women access and utilize the kits, our findings suggest that the provision of kits to women outside of the formal health system may be associated with increased risk of adverse outcomes.
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| 2. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Experimental Evidence on the Long-Run Impact of Community-Based Monitoring
- 2017
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Ingår i: American Economic Journal. - : American Economic Association. - 1945-7782 .- 1945-7790. ; 9:1, s. 33-69
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Tidskriftsartikel (refereegranskat)abstract
- We evaluate the longer run impact of a local accountability intervention in primary health care provision in Uganda. Short-run improvements in health care delivery and health outcomes remained in the longer run despite minimal follow-up. We find no impact on the quality of care or health. outcomes of a lower cost intervention that focused on encouraging participation but did not provide information on staff performance. We provide suggestive evidence that informed beneficiaries are more likely to identify and challenge (mis)behavior by providers and, as a result, turn their focus to issues that they can manage locally.
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| 3. |
- Björkman Nyqvist, Martina, et al.
(författare)
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High maternal mortality in Jigawa State, Northern Nigeria estimated using the sisterhood method
- 2017
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Ingår i: BMC Pregnancy and Childbirth. - : BMC (part of Springer Nature). - 1471-2393. ; 1:163
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Tidskriftsartikel (refereegranskat)abstract
- Background: Maternal mortality is extremely high in Nigeria. Accurate estimation of maternal mortality is challenging in low-income settings such as Nigeria where vital registration is incomplete. The objective of this study was to estimate the lifetime risk (LTR) of maternal death and the maternal mortality ratio (MMR) in Jigawa State, Northern Nigeria using the Sisterhood Method. Methods: Interviews with 7,069 women aged 15-49 in 96 randomly selected clusters of communities in 24 Local Government Areas (LGAs) across Jigawa state were conducted. A retrospective cohort of their sisters of reproductive age was constructed to calculate the lifetime risk of maternal mortality. Using most recent estimates of total fertility for the state, the MMR was estimated. Results: The 7,069 respondents reported 10,957 sisters who reached reproductive age. Of the 1,026 deaths in these sisters, 300 (29.2%) occurred during pregnancy, childbirth or within 42days after delivery. This corresponds to a LTR of 6.6% and an estimated MMR for the study areas of 1,012 maternal deaths per 100,000 live births (95% CI: 898-1,126) with a time reference of 2001. Conclusions: Jigawa State has an extremely high maternal mortality ratio underscoring the urgent need for health systems improvement and interventions to accelerate reductions in MMR. Trial registration: The trial is registered at clinicaltrials.gov ( NCT01487707 ). Initially registered on December 6, 2011. © 2017 The Author(s).
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| 4. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Incentivizing Safer Sexual Behavior : Evidence from a Lottery Experiment on HIV Prevention
- 2018
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Ingår i: American Economic Journal. - : American Economic Association. - 1945-7782 .- 1945-7790. ; 10:3, s. 287-314
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Tidskriftsartikel (refereegranskat)abstract
- We investigate the effect of a financial lottery program in Lesotho with relatively low expected payments but a chance to win a high prize conditional on negative test results for sexually transmitted infections. The intervention resulted in a 21.4 percent reduction in HIV incidence over two years. Lottery incentives appear to be particularly effective in targeting individuals with ex ante risky sexual behavior, consistent with the hypothesis that lotteries are more valued by individuals willing to take risks.
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| 5. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Mothers care more, but fathers decide: Educating parents about child health in Uganda
- 2017
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Ingår i: American Economic Review. - : American Economic Association. - 0002-8282. ; 107:5, s. 496-500
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Tidskriftsartikel (refereegranskat)abstract
- Research on intrahousehold decision-making generally finds that fathers have more bargaining power than mothers, but mothers put more weight on children's well-being. This suggests a tradeoff when targeting policies to improve child health: fathers have more power to change household behavior in ways that improve child health, but mothers might have a stronger desire to do so. This paper compares health classes in Uganda that enrolled either mothers or fathers. We find that educating mothers leads to greater adoption of health-promoting behaviors by the household. In addition, educating one parent leads to positive spillovers on the other spouse's health behaviors.
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| 6. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Reducing Child Mortality in the Last Mile : Experimental Evidence on Community Health Promoters in Uganda
- 2019
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Ingår i: American Economic Journal. - : American Economic Association. - 1945-7782 .- 1945-7790. ; 11:3, s. 155-192
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Tidskriftsartikel (refereegranskat)abstract
- The delivery of basic health products and services remains abysmal in many parts of the world where child mortality is high. This paper shows the results from a large-scale randomized evaluation of a novel approach to health care delivery In randomly selected villages, a sales agent was locally recruited and incentivized to conduct home visits, educate households on essential health behaviors, provide medical advice and referrals, and sell preventive and curative health products. Results after 3 years show substantial health impact: under 5-years child mortality was reduced by 27 percent at an estimated average cost of $68 per life-year saved.
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| 7. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Reducing Child Mortality in the Last Mile: A Randomized Social Entrepreneurship Intervention in Uganda
- 2017
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The delivery of basic health products and services remains abysmal in many parts of the world where child mortality is high. This paper shows the results from a largescale randomized evaluation of a novel “social entrepreneurship” approach to health care delivery. In randomly selected villages a sales agent was locally recruited and incentivized to conduct home visits, educate households on essential health behaviors, provide medical advice and referrals, and sell preventive and curative health products. Results after three years show substantial health impact: under-5 child mortality was reduced by 27% at an estimated cost of $71 per life-year saved.
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| 8. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Replication data for : Incentivizing Safer Sexual Behavior: Evidence from a Lottery Experiment on HIV Prevention
- 2019
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- We investigate the effect of a financial lottery program in Lesotho with relatively low expected payments but a chance to win a high prize conditional on negative test results for sexually transmitted infections. The intervention resulted in a 21.4 percent reduction in HIV incidence over two years. Lottery incentives appear to be particularly effective in targeting individuals with ex ante risky sexual behavior, consistent with the hypothesis that lotteries are more valued by individuals willing to take risks.
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| 9. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Replication data for: Reducing Child Mortality in the Last Mile: Experimental Evidence on Community Health Promoters in Uganda
- 2019
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The delivery of basic health products and services remains abysmal in many parts of the world where child mortality is high. This paper shows the results from a large-scale randomized evaluation of a novel approach to health care delivery. In randomly selected villages, a sales agent was locally recruited and incentivized to conduct home visits, educate households on essential health behaviors, provide medical advice and referrals, and sell preventive and curative health products. Results after 3 years show substantial health impact: under 5-years child mortality was reduced by 27 percent at an estimated average cost of $68 per life-year saved.
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| 10. |
- Björkman Nyqvist, Martina, et al.
(författare)
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Understanding Human Trafficking Using Victim-Level Data
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Quantitative research on human trafficking is scant due to lack of data. This study makes use of a unique survey we collected on former victims of trafficking and vulnerable women and girls in the Philippines. We start by exploring the correlates of trafficking and show that household composition (in particular the presence of older sisters) and plausibly exogenous measures of health and economic shocks predict the likelihood of being tracked. We then study the effects of trafficking on victims' intertemporal and risk preferences using entropy balancing. We find that trafficking victims are not differentially patient, but they are more risk-loving. Our novel data and findings are pertinent to the design of policies intending to prevent trafficking and reintegrate victims.
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