BACKGROUND: Ethiopia adopted a new strategy called integrated community case management to address common childhood illness (ICCM). This strategy has been introduced in some rural districts of Bale zone. It has multiple functions, involving assessment of sick children at community health post levels. Despite this, the efficacy of this strategy has not been investigated. Aim: This study aimed to assess the level of ICCM service utilisation and factors influencing this at health posts in Agarfa district. METHODS: Cross sectional and phenomenological methodologies were employed in this study. Data were collected from 401 mothers using questionnaires and 29 participants using in-depth interviews. Quantitative data were analysed using both descriptive and inferential statistical approaches. Thematic analysis was used for the qualitative data. RESULT: The utilsation of ICCM services is limited among caregivers in rural communities. There is a range of factors responsible for the limited utilisation. Examples of these include absence of health extension workers at health posts, caregivers’ negative perception of ICCM service, socio-cultural factors, level of education and household finance. The most common childhood illnesses noted were diarrhoea, followed by fever and cough. Caregivers seek help from HEWs at health posts two or more days after idenfying signs and symptoms of these illnesses. CONCLUSION: Behavioural messages to address prevailing negative attitudes and socio-economic barriers to accessing health care would help improve uptake of ICCM services / Health Studies / M.A. (Public Health)

Many Low and Middle Income Countries (LAMICs) still lack sufficient health research capacity to build a local evidence-base with which to inform policy and improve population health. Recognising this, The 2013 World Health Report called for all nations to be producers of health research. To achieve this, new strategies that can develop sustainable locally-led capacity are required. Among the health research capacities needed, ability to conduct clinical trials is important. However, there is no evidence-informed guidance on the best ways to develop locally-led trial capacity. This thesis aims to fill this gap. Three cases-studies using qualitative methods to explore the barriers and enablers to locally-led trial conduct were conducted in Ethiopia, Cameroon and Sri Lanka. Current and potential local trial researchers and health research system stakeholders were recruited. A synthesis of the health research capacity development literature was conducted to compare the case-studies’ findings with wider published perspectives. These data permit an examination of the key issues facing the development of locally-led trial capacity in LAMICs. Barriers and enablers to locally-led trial conduct were found at macro, institutional and individual levels. Although different country research systems, and institutions and individuals within them, were variably successful at conducting trials, the key issues and mechanisms influencing successful trial undertaking were largely similar. Agreement among the case-studies and with the diverse literature suggests that many of the findings will be transferable to other LAMICs, and are also of relevance to other health research methods. A conceptual framework explaining the antecedents and consequences of locally-led trial undertaking in LAMICS is presented. This identifies the following factors as important for supporting locally-led trial undertaking: awareness and appreciation for health research and clinical trials; motivation to conduct clinical trials; availability of human resources with trial knowledge and technical skills; research leadership capabilities; ability to form collaborations, effective teams and acquire resources; trial management dedicated to sustainable capacity development and producing useful research; and system-wide prioritisation of health research. The theories of change presented within this framework are used to develop practical recommendations for development of locally-led trial capacity in LAMICs. These recommendations have four inter-related goals: fostering pro-research cultures in stakeholder institutions; developing trial leaders and staff; providing a facilitative operational environment for trials; and ensuring trial research has an impact. However, to create the will to enact change, advocacy from research champions and conducting trials in a way that benefits local institutions and population health is needed.

Ethiopia adopted a new strategy called integrated community case management to address common childhood illness (ICCM). This strategy has been introduced in some rural districts of Bale zone. It has multiple functions, involving assessment of sick children at community health post levels. Despite this, the efficacy of this strategy has not been investigated. Aim: This study aimed to assess the level of ICCM service utilisation and factors influencing this at health posts in Agarfa district. METHODS: Cross sectional and phenomenological methodologies were employed in this study. Data were collected from 401 mothers using questionnaires and 29 participants using in-depth interviews. Quantitative data were analysed using both descriptive and inferential statistical approaches. Thematic analysis was used for the qualitative data. RESULT: The utilsation of ICCM services is limited among caregivers in rural communities. There is a range of factors responsible for the limited utilisation. Examples of these include absence of health extension workers at health posts, caregivers’ negative perception of ICCM service, socio-cultural factors, level of education and household finance. The most common childhood illnesses noted were diarrhoea, followed by fever and cough. Caregivers seek help from HEWs at health posts two or more days after idenfying signs and symptoms of these illnesses. CONCLUSION: Behavioural messages to address prevailing negative attitudes and socio-economic barriers to accessing health care would help improve uptake of ICCM services / Health Studies / M. A. (Public Health)

No description available.

Au milieu du siècle dernier, les traités relatifs aux droits de l'homme et les normes éthiques de la réglementation de la recherche n'ont pas suffi à prévenir les violations de la dignité de la personne humaine dans les expériences médicales pratiquées contre les minorités sociales. Il existe, aujourd’hui, un ensemble complexe de règles qui visent non seulement à protéger les volontaires, mais aussi à garantir un accès équitable aux résultats de la recherche. Les contradictions et les interprétations erronées de ces normes limitent toutefois la pleine réalisation de ces garanties, essentielles par rapport aux minorités sociales, face à leur manque de représentation politique dans la société. Dans ce sens, une étude exploratoire-descriptive a été réalisée en passant en revue la littérature et en appliquant un questionnaire destiné à comparer les réponses présentées par les comités d'éthique du Brésil et de la France. Il a été conclu qu'il est impératif que le principe du partage des avantages soit largement appliqué dans toutes les recherches, y compris celles qui utilisent des données personnelles et des échantillons corporels, notamment en ce qui concerne les minorités sociales, afin que les progrès scientifiques soient accessibles à tous. / In the middle of the last century, treaties of human rights and set ethical principles regarding human experimentation were not enough to prevent, in practice, violations of the dignity of the human person in medical experiments practiced in social minorities. Nowadays, there is a complex set of rules that aim not only to protect volunteers but also to ensure equitable access to research results. Contradictions and misinterpretations of these norms, however, limit the full realization of these guarantees, essential in relation to social minorities, in face of their lack of political representation in society. In this sense, an exploratory-descriptive study was carried out by reviewing the literature and applying a questionnaire designed to compare the responses presented by independent ethics committees from Brazil and France. It was concluded that it is imperative that the benefit-sharing be broadly applied in all research, including those that use personal data and body samples, especially with regard to social minorities in order to make progress increasingly accessible to all. / Em meados do século passado, tratados de direitos humanos e normas éticas de regulação da pesquisa não foram suficientes para impedir, na prática, violações à dignidade da pessoa humana em experiências médicas praticadas em minorias sociais. Hodiernamente, há um complexo de normas que objetivam não só proteger voluntários como lhes garantir equitativo acesso aos resultados das pesquisas. Contradições e interpretações equivocadas dessas normas, entretanto, limitam a plena efetivação dessas garantias, essenciais em relação às minorias sociais, diante da sua falta de representação política na sociedade. Neste sentido, um estudo exploratório-descritivo foi realizado através de revisão da literatura e aplicação de questionário elaborado para comparar as respostas apresentadas pelos comitês de revisão ética do Brasil e da França. Concluiu-se que é imprescindível que o preceito da repartição de benefícios seja aplicado, na prática, de forma ampla, em todas as pesquisas, inclusive naquelas que utilizam dados pessoais e amostras corporais, especialmente com relação às minorias sociais, para que as pesquisas oportunizem a todos a percepção do progresso científico-tecnológico.

Black American women have the highest screening rates for cervical cancer among all the ethnic groups in the United States. Even though evidence from the literature suggests that the number of deaths from cervical cancer in the United States could be reduced by preventive screening, this particular minority population still suffers disproportionately higher mortality from the disease than the other minority and majority populations in the United States. This study was proposed to investigate cancer screening disparities among different subpopulations of women residing in the United States during 1999, and to recommend public health interventions that could potentially increase cervical cancer screening rates, thereby decreasing differential mortality rates for cervical cancer among these subpopulations. The Preventive Health Model in conjunction with data from the 1999 Behavioral Risk Factor Surveillance System was used to identify the covariates of cervical cancer screening behavior in an ethnically diverse population of American women residing in the United States during the specified timeframe. Univariate, bivariate and multivariable logistic regression procedures were used to evaluate the association between each one of the independent variables and the dependent variable (compliance with the 1999 cervical screening guidelines of the American Cancer Society). One of the major findings of this study was that Black, White and Hispanic American women were more similar in their screening behavior than dissimilar. The study also showed that the disparity in cervical cancer screening behavior in this population is in age, rather than in ethnic origin. Black, White and Hispanic American women of child-bearing age (18-44 years) were more likely to be compliant with the 1999 cervical cancer screening guidelines of the American Cancer Society, than Black, White and Hispanic American women who were not of child-bearing age (45 to 64 years). Implications for public health intervention studies are discussed, and recommendations made for future research in this area of cervical cancer screening behavior.

University of Macau / Faculty of Education

Continued documentation of the disproportionate burden of ill health faced by Aboriginal Peoples in Canada raises questions about the gap between what is known and what action is being taken to improve Aboriginal health in Canada. In order to explore this puzzle of knowledge translation (KT), a conceptual framework was developed by synthesizing the KT literature with the Aboriginal health research literature. Using this framework as a guide, this study explored the idea of KT within one Aboriginal health research context – the Network Environments for Aboriginal Research British Columbia (NEARBC). Concepts, ideas, and patterns drawn from the systematic thematic analysis of semi-structured qualitative interviews highlight the complexity of Aboriginal KT and the challenges that lie ahead. The lessons learned from these challenges are reviewed and opportunities for KT to help transform the discourse and practice of Aboriginal health research and policy in Canada discussed.

Continued documentation of the disproportionate burden of ill health faced by Aboriginal Peoples in Canada raises questions about the gap between what is known and what action is being taken to improve Aboriginal health in Canada. In order to explore this puzzle of knowledge translation (KT), a conceptual framework was developed by synthesizing the KT literature with the Aboriginal health research literature. Using this framework as a guide, this study explored the idea of KT within one Aboriginal health research context – the Network Environments for Aboriginal Research British Columbia (NEARBC). Concepts, ideas, and patterns drawn from the systematic thematic analysis of semi-structured qualitative interviews highlight the complexity of Aboriginal KT and the challenges that lie ahead. The lessons learned from these challenges are reviewed and opportunities for KT to help transform the discourse and practice of Aboriginal health research and policy in Canada discussed.

Over the past two decades there has been an upsurge in interest in structural equation modelling (SEM). Applications abound in the social sciences and econometrics, but the use of this multivariate technique is not so common in public health research. This dissertation discusses the methodology, the criticisms and practical problems of SEM. We examine actual applications of SEM in public health research. Comparisons are made between multiple regression and SEM and between factor analysis and SEM. A complex model investigating the utilization of antenatal care services (ANC) by migrant women in Belgium is analysed using SEM. The dissertation concludes with a discussion of the results found and on the use of SEM in public health research. Structural equation modelling is recommended as a tool for public health researchers with a warning against using the technique too casually. / Mathematical Sciences / M. Sc. (Statistics)