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Rawal Medical Journal. 2018 Jul-Sep; 43(3):462-466.Objective: To evaluate the nutritional status of the Pakistani children aged 2-5 years. Methods: A cross-sectional study of 1474 children, aged 2-5 years, was undertaken from Multan, Lahore, Rawalpindi and Islamabad, Pakistan from March-June, 2016. The head circumference (HdC) measurement of each subject was taken. Following the WHO age and sex-specific cut-off points, nutritional status of children was determined. Results: The mean age and HdC of the total subjects was4.15±0.87 years and 48.51 ±1.79 cm, respectively. Mean HdC increased with advancement of age in both boys and girls. Moderate under-nutrition was more prevalent than severe under-nutrition in both genders. Based on the HdC, the overall (age and sex combined) percentage of under-nourishment was 16.2 while these percentages were 16.4 and 15.8 for girls and boys, respectively. Conclusion: The study showed that a considerable number of Pakistani children were undernourished. A high rate of under-nutrition was observed in girls than in boys.
The association between voucher scheme and maternal healthcare services among the rural women in Bangladesh: A cross sectional study.
Bangladesh Journal of Medical Science. 2018; 17(4):545-555.Background: Maternal health voucher scheme, providing financial support to poor women, is popularly known as subsidies in maternity care services including antenatal, delivery and postnatal care and also economic barriers while seeking treatment from qualified service providers. The aim of this study is to evaluate the association of voucher scheme on receiving maternal healthcare services among the rural women in Bangladesh. Methods: This is a cross sectional study where total sample size was (n=500) rural women who were selected by using convenience sampling method. Among them, 250 women were voucher scheme receivers and other 250 women were non-voucher scheme receivers. A structured questionnaire was adopted for data collection between November and December 2015. In the final analysis, cross tabular analysis and logistic regression model were used, and adjusted odds ratios (ORs) were reported. Results: The study found a strong relation between voucher scheme and maternal healthcare services among the rural women in Bangladesh where majority (88.4%) voucher scheme receivers received information or treatment of Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs) while non-voucher scheme receivers received only 10%. Most of the respondents (93%) voucher scheme receivers received at least 3 times of antenatal care visit; but only 28% received non-voucher scheme receivers at least 3 times of antenatal care visit. Voucher scheme receivers received 17.127 times more likelihood to receive skilled birth attendance and 25.344 times more likelihood to receive institutional delivery services and positively significant (5 percent) compared to those who did not receive maternal heath voucher scheme. Moreover, 92.4% voucher receivers received transport cost and 73.2%, received safe home delivery services while 22.8% non-voucher scheme receivers received transport cost and only 20.4% received safe home delivery services. Majority (94%) voucher scheme receivers received long time birth control services while only 19.2% non-voucher scheme receivers received long time birth control services. Conclusion: Women who did not receive maternal health voucher scheme found the status of lower antenatal, delivery and postnatal care services receiving trends compared to the women who received the maternal health voucher scheme. It is recommended an effective monitoring system and necessary interventions getting overall developed health status in Bangladesh. © 2018, Ibn Sina Trust. All Rights Reserved.
Reproductive Health Matters. 2018 Dec; 26(52):1544770.Add to my documents.
Reproductive Biomedicine and Society Online. 2018 Aug; 6:45-54.While the majority of East Asian countries embraced the modern intrauterine device (IUD) during the 1960s, the sale and distribution of the IUD in Japan was not authorized until 1974. In this paper, I address why the Japanese Government took so long to permit the use of the IUD. Firstly, I examine scientific debates in Japan during the early 1950s on the efficacy of the IUD and associated health risks, to illustrate how the Government's conservative attitude was fostered by a co-constitutive relationship between health officials and leading obstetrician-gynaecologists who believed that the IUD was dangerous and likely to induce abortion. I also trace the Japanese Government's rapidly changing attitude through the 1960s, and analyse the influential interaction between national policy making and the enthusiastic response of a small number of Japanese doctors to the transnational movement to curb population growth in developing countries. I argue that the specific ways in which biomedical discourse was shaped by the sociopolitical position of doctors in relation to the Government's health administration explains the Japanese Government's resistance to use of the IUD. However, I also note that the Government's dramatic change in attitude was influenced directly by transnational reproductive politics. This paper will enhance the history of reproductive politics in post-war Japan.
Pharmaceuticals and modern statecraft in South Africa: the cases of opium, thalidomide and contraception.
Medical Humanities. 2018 Dec; 44(4):253-262.This article provides a history of three pharmaceuticals in the making of modern South Africa. Borrowing and adapting Arthur Daemmrich's term 'pharmacopolitics', we examine how forms of pharmaceutical governance became integral to the creation and institutional practices of this state. Through case studies of three medicaments: opium (late 19th to early 20th century), thalidomide (late 1950s to early 1960s) and contraception (1970s to 2010s), we explore the intertwining of pharmaceutical regulation, provision and consumption. Our focus is on the modernist imperative towards the rationalisation of pharmaceutical oversight, as an extension of the state's bureaucratic and ideological objectives, and, importantly, as its obligation. We also explore adaptive and illicit uses of medicines, both by purveyors of pharmaceuticals, and among consumers. The historical sweep of our study allows for an analysis of continuities and changes in pharmaceutical governance. The focus on South Africa highlights how the concept of pharmacopolitics can usefully be extended to transnational-as well as local-medical histories. Through the diversity of our sources, and the breadth of their chronology, we aim to historicise modern pharmaceutical practices in South Africa, from the late colonial era to the Post-Apartheid present. (c) Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Medicaid Family Planning Expansions: The Effect of State Plan Amendments on Postpartum Contraceptive Use.
Journal of Women's Health. 2018 Nov 28;OBJECTIVE: To determine the effect of state Medicaid family planning (FP) programs transitioning from a Section 1115 waiver to a State Plan Amendment (SPA) on reproductive health outcomes. MATERIALS AND METHODS: Data were from the Pregnancy Risk Assessment Monitoring System on 75,082 women who had a live birth between 2007 and 2013 and were living in one of nine states. We performed a difference-in-differences analysis to quantify the effect of the transition on postpartum contraceptive (PPC) use and unintended births (UBs). RESULTS: Over 80% of the sample reported using PPC; half reported an UB. The odds of PPC use among women who were living in a study state and gave birth after the transition were 1.14 times that of women who were living in a comparison state and/or gave birth before the transition (95% confidence interval: 1.04-1.24). CONCLUSIONS: Findings suggest that women living in states that transitioned from a waiver to SPA experienced an increased likelihood of PPC compared with those living in comparison states.
Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health.
BMC Pregnancy and Childbirth. 2018 Nov 20; 18(1):449.BACKGROUND: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth. METHODS: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI. RESULTS: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy. CONCLUSION: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.
When things fall apart: local responses to the reintroduction of user-fees for maternal health services in rural Malawi.
Reproductive Health Matters. 2018 Nov 2; 1-11.Despite the strong global focus on improving maternal health during past decades, there is still a long way to go to ensure equitable access to services and quality of care for women and girls around the world. To understand widely acknowledged inequities and policy-to-practice gaps in maternal health, we must critically analyse the workings of power in policy and health systems. This paper analyses power dynamics at play in the implementation of maternal health policies in rural Malawi, a country with one of the world's highest burdens of maternal mortality. Specifically, we analyse Malawi's recent experience with the temporary reintroduction of user-fees for maternity services as a response to the suspension of donor funding, a shift in political leadership and priorities, and unstable service contracts between the government and its implementing partner, the Christian Health Association of Malawi. Based on ethnographic research conducted in 2015/16, the article describes the perceptions and experiences of policy implementation among various local actors (health workers, village heads and women). The way in which maternity services "fall apart" and are "fixed" is the result of dynamic interactions between policy and webs of accountability. Policies meet with a cascade of dynamic responses, which ultimately result in the exclusion of the most vulnerable rural women from maternity care services, against the aims of global and national safe motherhood policies.
The need for contraception in patients taking prescription drugs: a review of FDA warning labels, duration of effects, and mechanisms of action.
Expert Opinion On Drug Safety. 2018 Nov 3; 1-13.INTRODUCTION: This review provides a guide for the rational use of prescription drugs in patients of reproductive age. Areas covered: A comprehensive retrieval of the labels of FDA-approved drugs was performed to identify drugs where the label recommends contraceptive use during and/or after treatment. The acquired data were analyzed and organized into a table. Contraception was recommended or mandated for 268 single-ingredient drugs. These could be divided into four main categories, with many having effects across several categories: 177 drugs required contraception because they were associated with pregnancy loss or stillbirth, 177 drugs were associated with teratogenesis, 136 were associated with non-teratogenic adverse peri- or postnatal effects on the fetus (e.g. low birth weight), and 44 were associated with decreased efficacy of contraception or a change in ovulatory cycle. We also discuss the period of time contraception is required, as well as the known or hypothesized reasons for the reproductive toxicity of these agents. Expert opinion: We have provided a comprehensive overview of the FDA-approved drugs where the warning labels currently stipulate that contraception should be used. Although other references are available for clinicians, this review provides a useful source of information regarding the single-ingredient prescription drugs that may affect the outcome of pregnancy. This information is particularly relevant for researchers, as it provides an overview of the different drugs with reproductive toxicity, and because it highlights the specific needs for future research. In particular, more work (especially epidemiological studies) is needed to clarify the clinical relevance of these findings, most of which were obtained through animal studies.
Culture, Health and Sexuality. 2018 Nov 29; 11 p.Polygyny is a matrimonial union in which a single man is simultaneously married to multiple wives. On a daily basis, women in polygynous unions suffer from financial, emotional and physical burdens. This study explores women's perceptions of this matrimonial regime and the factors influencing their sexual health decision-making in Cameroon. Drawing on interviews with twenty-three women aged 23 to 80 years living in polygynous unions, we explore women’s daily life and perceptions on polygyny. Using content analysis, meaning units relating to respondents’ experiences and perceptions were identified and condensed into codes and categories that were later grouped into themes. Five themes emerged – refusal and tolerance; heavy workload and responsibility; lack of power in sexual health decision-making; discrimination and unequal treatment of spouses; and emotional suppression. Women reported emotional suppression, limited rights, discrimination and poor living conditions as being the most significant problems that they encountered. Addressing the discrimination faced by women in polygynous unions will entail adopting and implementing laws to protect women’s rights and promote their empowerment.
Washington, D.C., Population Council, The Evidence Project, 2018 Mar. 8 p. (Case Study)Women of reproductive age in Cambodia, and many other developing countries, comprise a large part of factories’ workforce. Integrating family planning and reproductive health information and services into factories can improve workers’ health and help countries achieve FP2020 commitments. This case study looks at the process of how the Cambodian Ministry of Labor and Vocational Training launched, as formal policy, a set of workplace health infirmary guidelines for enterprises. What made this policy process unique for Cambodia – and what can be replicated by health advocates elsewhere – is that a group of organizations typically focused on public health policy successfully engaged on labor policy with a labor ministry. This case study describes the policy process, which was underpinned by the strategic use of evidence in decision-making and has been hailed by government, donors, civil society and industry as a success. The learnings presented in this case study should be useful to health advocates, labor advocates, and program designers.
Bulletin of the World Health Organization. 2018 Dec; 96(12):798-799.Add to my documents.
Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middl-income countries.
BMJ Global Health. 2018 Dec 1; 3(6):e001011.Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA) are the most widely employed, standardised tools that generate health service delivery data in LMICs. We ascertained the use of SPA/SARA surveys for assessing the quality of MNH services using a two-step approach: a SPA/SARA questionnaire mapping exercise in line with WHO’s Quality of Care (QoC) Framework for pregnant women and newborns and the WHO quality standards for care around the time of childbirth; and a scoping literature review, searching for articles that report SPA/SARA data. SPA/SARA surveys are well suited to assess the WHO Framework’s cross-cutting dimensions (physical and human resources); SPA also captures elements in the provision and experience of care domains for antenatal care and family planning. Only 4 of 31 proposed WHO quality indicators around the time of childbirth can be fully generated using SPA and SARA surveys, while 19 and 23 quality indicators can be partially obtained from SARA and SPA surveys, respectively; most of these are input indicators. Use of SPA/SARA data is growing, but there is considerable variation in methods employed to measure MNH QoC. With SPA/SARA data available in 30 countries, MNH QoC assessments could benefit from guidance for creating standard metrics. Adding questions in SPA/SARA surveys to assess the WHO QoC Framework’s provision and experience of care dimensions would fill significant data gaps in LMICs.
New York, New York, UN Women, 2018. 342 p.This flagship report provides a comprehensive and authoritative assessment of progress, gaps and challenges in the implementation of the Sustainable Development Goals (SDGs) from a gender perspective. The report monitors global and regional trends in achieving the SDGs for women and girls based on available data, and provides practical guidance for the implementation of gender-responsive policies and accountability processes. As a source of high-quality data and policy analysis, the report is a key reference and accountability tool for policymakers, women’s organizations, the UN system, and other stakeholders. This report lays the basis for robust, gender-responsive monitoring of the 2030 Agenda for Sustainable Development by: showing how gender equality is central to the achievement of all 17 SDGs and arguing for an integrated and rights-based approach to implementation; explaining gender data gaps and challenges for robust monitoring and establishing starting points and trends across a range of gender-related indicators based on available data; providing concrete guidance on policies to achieve two strategic targets under SDG 5 (violence and unpaid care) and outlining how these policies are synergistic with other goals and targets; and setting an agenda for strengthening accountability for gender equality commitments at global, regional, and national levels.
Setting the national agenda and sharing contraceptive responsibilities: Spotlight on vasectomy access and uptake in South Africa. Report.
[Cape Town, South Africa], AIDS Accountability International, . 46 p.This report represents exploratory consultative work in the area of vasectomy awareness, uptake and provision in South Africa and seeks to strengthen a regional discussion on shared contraceptive responsibility as a gender transformative approach.
Mapping evidence on decision-making on contraceptive use among adolescents: a scoping review protocol.
Systematic Reviews. 2018 Nov 20; 7(1):201.BACKGROUND: Contraceptive use among adolescents remains consistently low globally. Numerous studies have been done investigating factors that contribute to low contraceptive prevalence rates in this special population. It is particularly vital to understand decision-making processes that adolescents undergo when deciding whether or not to use contraceptives. Therefore, this scoping review seeks to map available evidence on decision-making processes in contraceptive use among adolescents. METHODS: We will conduct a scoping review to explore, describe and map literature on the adolescent decision-making regarding contraceptive use. The primary search will include peer-reviewed and review articles. Databases, including PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct and Scopus, will be searched for articles that meet the eligibility criteria. Keyword searches will be used, and for articles included after title screening, abstract and full articles will be screened by two independent reviewers with a third as a decider on any disputes. Content analysis will be used to present the narrative account of the reviews. DISCUSSION: Understanding how adolescents make decisions about whether or not to use contraception is essential for improving contraceptive prevalence rates in this special population. It is envisioned that the results from this review will highlight key evidence on how adolescent make decisions regarding contraceptive use as well as gaps and opportunities for future research. It will also be important in enhancing and re-focusing adolescent sexual and reproductive health policies and programmes.
JAMA. 2018 Sep 18; 320(11):1098.Add to my documents.
Mapping the extent to which performance-based financing (PBF) programs reflect quality, informed choice and voluntarism and implications for family planning services A review of indicators.
Washington, D.C., Population Council, The Evidence Project, 2018 Sep. 23 p. (Research Report)Results-based financing (RBF) initiatives, which operate within the much larger financial and programming contexts of health systems, aim to expand coverage, improve quality and reduce consumer financial obligations at the country level in line with a nation’s decision to progress toward universal health coverage. RBF programs have the potential to ensure that clients’ needs for quality services are met through use of strategic incentives in health care provision and promoting more client-centered healthcare systems. Performance-based financing (PBF) programs are considered a specific subset of RBF initiatives and are distinguished by a focus on monetary incentives to healthcare providers for achieving agreed performance measure under certain conditions. While both PBF, which uses financial disbursements to incentivize health service delivery and quality, and rights-based programming have informed at different times efforts to strengthen and scale FP services, there is has been little done to understand the linkages between PBF and a rights-based approach (RBA) to FP services. To address this gap, a review of PBF operations manuals was undertaken together with an analysis of PBF indicators relevant to FP services. This paper presents the results of the analysis of PBF indicators from country-sourced operational documents to determine the extent to which FP indicators are sensitive to the principles associated with an RBA. The review catalogued FP indicators used in PBF programs and assessed their sensitivity to the rights principles. The relevant indicators were sources through 23 operational documents and 18 quality checks. We found 452 FP-related indicators, 57 were for quantity-based performance indicators and 395 questions were used to assess the quality of FP services. The majority of quantity-based performance indicators related to contraceptive service utilization. Fewer quantity-based indicators linked performance incentives to FP counselling, antenatal care, provision or referral by community health workers and one related to demand side incentive for FP counseling. The rights principles most often addressed are availability, quality, including privacy and confidentiality, and informed choice and acceptability and accountability were addressed to a lesser extent. There was no implicit link to the rights principles of accessibility, non-discrimination, and agency. The review shows that existing PBF indicators capture some key elements of an RBA. For instance, aspects of quality and availability are extensively measured. Adapting existing measures could help to ensure existing indicators better align with an RBA. For example, informed choice is tracked in several PBF programs now but with further adoption and adaptation of the method information index and related counseling quality indicators, it is reasonable to expect a greater alignment of PBF with rights principles. Despite the opportunity for greater integration, there are challenges inherent in measuring some dimensions of an RBA, particularly related to client-provider interactions, service users’ experience and engagement. For instance, agency and accessibility require information from the consumer perspective that is not easily observed by third parties.
Mapping the extent to which performance-based financing (PBF) programs reflect quality, informed choice, and voluntarism and implications for family planning services A review of PBF operational manuals.
Washington, D.C., Population Council, The Evidence Project, 2018 Sep. 38 p. (Research Report)Expanding access to and use of voluntary family planning (FP) services is a well-established global health goal– it is a specific target under the Sustainable Development Goal (SDG) of good health and well-being, an integral component of Every Woman Every Child (EWEC), and the overall objective of the Family Planning 2020 (FP2020) partnership, among other initiatives. One promising approach for achieving global voluntary FP goals is performance-based financing (PBF), which deploys financial incentives to the health system to improve service availability, utilization, and quality as well as addressing some public financial management bottlenecks by directly targeting resources to facilities based on performance. Setting global voluntary FP goals implies following a rights-based approach to family planning, which uses a set of standards and principles to guide program assessment, planning, implementation, monitoring, and evaluation that enables individuals and couples to decide freely and responsibly the number and spacing of their children, to have the information and services to do so, and to be treated equitably and free of discrimination. While both PBF, which uses financial disbursements to incentivize health service delivery and quality, and rights-based programming have informed efforts to strengthen and scale FP services, there are gaps in understanding the linkages between PBF and a rights-based approach (RBA) to FP services. To address this gap, a review of performance-based financing (PBF) operations manuals was undertaken together with an analysis of PBF indicators relevant to FP services. This report assesses whether existing FP indicators are sensitive to the principles associated with an RBA.
Can community health workers manage uncomplicated severe acute malnutrition? A review of operational experiences in delivering severe acute malnutrition treatment through community health platforms?
Maternal and Child Nutrition. 2018 Oct 13; 13 p.Community health workers (CHWs) play an important role in the detection and referral of children with severe acute malnutrition (SAM) in many countries. However, distance to health facilities remains a significant obstacle for caregivers to attend treatment services, resulting in SAM treatment coverage rates below 40% in most areas of intervention. The inclusion of SAM treatment into the current curative tasks of CHWs has been proposed as an approach to increase coverage. A literature review of operational experiences was conducted to identify opportunities and challenges associated with this model. A total of 18 studies providing evidence on coverage, clinical outcomes, quality of care, and/or cost-effectiveness were identified. The studies demonstrate that CHWs can identify and treat uncomplicated cases of SAM, achieving cure rates above the minimum standards and reducing default rates to less than 8%. Although the evidence is limited, these findings suggest that early detection and treatment in the community can increase coverage of SAM in a cost-effective manner. Adequate training and close supervision were found to be essential to ensure high-quality performance of CHWs. Motivation through financial compensation and other incentives, which improve their social recognition, was also found to be an important factor contributing to high-quality performance. Another common challenge affecting performance is insufficient stock of key commodities (i.e., ready-to-use therapeutic food). The review of the evidence ultimately demonstrates that the successful delivery of SAM treatment via CHWs will require adaptations in nutrition and health policy and practice.
Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.
International Quarterly of Community Health Education. 2018 Jul; 38(4):259-267.In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.
Lancet. 2018 May 12; 391(10133):1886.Add to my documents.
Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services.
Health Research Policy and Systems. 2017 Dec 28; 15(Suppl 2):106.BACKGROUND: Effective stakeholder engagement in research and implementation is important for improving the development and implementation of policies and programmes. A varied number of tools have been employed for stakeholder engagement. In this paper, we discuss two participatory methods for engaging with stakeholders - participatory social network analysis (PSNA) and participatory impact pathways analysis (PIPA). Based on our experience, we derive lessons about when and how to apply these tools. METHODS: This paper was informed by a review of project reports and documents in addition to reflection meetings with the researchers who applied the tools. These reports were synthesised and used to make thick descriptions of the applications of the methods while highlighting key lessons. RESULTS: PSNA and PIPA both allowed a deep understanding of how the system actors are interconnected and how they influence maternal health and maternal healthcare services. The findings from the PSNA provided guidance on how stakeholders of a health system are interconnected and how they can stimulate more positive interaction between the stakeholders by exposing existing gaps. The PIPA meeting enabled the participants to envision how they could expand their networks and resources by mentally thinking about the contributions that they could make to the project. The processes that were considered critical for successful application of the tools and achievement of outcomes included training of facilitators, language used during the facilitation, the number of times the tool is applied, length of the tools, pretesting of the tools, and use of quantitative and qualitative methods. CONCLUSIONS: Whereas both tools allowed the identification of stakeholders and provided a deeper understanding of the type of networks and dynamics within the network, PIPA had a higher potential for promoting collaboration between stakeholders, likely due to allowing interaction between them. Additionally, it was implemented within a participatory action research project. PIPA also allowed participatory evaluation of the project from the perspective of the community. This paper provides lessons about the use of these participatory tools.
Stunting on children under five years on family of beneficiary family hope program in Wonogiri district, Central Java.
International Journal of Community Medicine and Public Health. 2018 Jul; 5(7):2735-2741.Background: The nutritional status of infants and toddlers is one indicator of public nutrition, and even has developed into one of the indicators of health and welfare. Basic Health Research (Riskesdas) in 2013 showed that 37,2% children under five suffering from nutritional status is stunting. One of the efforts that have been made by the Indonesian government to reduce malnutrition in infants and toddlers is through a program that is integrated with the health sector namely Conditional Cash Transfer Program (Program Keluarga Harapan). The specific objectives were to identify the characteristics of families recieve Conditional Cash Transfer Program and analysis stunting children under five years in families receiving Conditional Cash Transfer Program in Baturetno subdistric, Wonogiri district. Methods: The study was conducted in the subdistrict of Baturetno, Wonogiri district and has collected a total of 112 infants of families Conditional Cash Transfer Program participants. Sampling of children under five years was done purposively. This study was conducted from July to August 2017. Results: The proportion of children who stunting quite high at 33.0% higher than the results of the Nutritional Status Monitoring in 2016 amounted to 27.5%. If stunting is associated with the age group of stunting problems occur in all age groups in the amount of 31.3% in under 23 months and 34.3% at 23 months upwards of 31.3% children under five short, as much as 25.0% children under five are overweight according to height (weight for height) is normal and thus potentially becoming obese. Conclusions: The implementation of weight monitoring should be monitored the height of children under five in the hope family program.
Impact of conditional cash transfer scheme (MAMATA) on the prevalent MCH care practices in rural areas of Ganjam district, Orissa: a descriptive study.
International Journal of Community Medicine and Public Health. 2018 Aug; 5(8):3537-3543.Background: RMNCH services are provided in an integrated manner to it’s beneficiaries under the premise of Primary Health Care. The utilization rates for such services have remained abysmally low and stagnated over the years. The problem lies in failure to generate a demand for such services among it’s beneficiaries. MAMATA a conditional cash transfer scheme implemented in Odisha, aims to bring around radical changes by addressing the issue of demand generation. The objectives of the study were to assess the implementation of MAMATA scheme services in the study area and to assess the impact made by the scheme in their life. Methods: The study was conducted on 200 women, who were randomly selected from the 903 pregnant women registered under Mamata Scheme from a randomly selected block of Odisha. They were then followed up for a period of 15 months. Results: Implementation of the scheme in the district was smooth, the instalments were paid regularly in most of the cases without any delay. Impact of the scheme- 98% got adequate rest during pregnancy, because of the scheme. 95% utilized the money for purchasing nutritious food and procuring medicines. The scheme has also helped develop a health seeking attitude in most of the beneficiaries (85%). 97% felt a sense of empowerment and independence compared to the past. Conclusions: The benefits of MAMATA scheme percolated beyond the boundaries of demand generation. It also brought about a sense of empowerment and independence among it’s beneficiaries.