Includes bibliographical references. / Mpigi District is a rural district in Uganda with high maternal morbidity and mortality. While most pregnant women in Uganda attend antenatal clinics, few ultimately deliver their babies in a health facility. Interventions have not achieved increased utilisation of maternal services. A review of maternal determinants and factors associated with health facility delivery is the focus of this study. To determine the reasons why women deliver in health facilities; to identify the maternal determinants or factors associated with health facility delivery; and to determine the socio-demographic characteristics of women who deliver in health facilities. This quantitative, descriptive, cross-sectional study of 257 women who delivered in the Mpigi District in 2008/2009 used face-to-face interviews at which a questionnaire was administered. Women delivered in health facilities because they expected a safe delivery. Ten factors were found to be significantly associated with a higher possibility of health facility delivery: eight or more years of education (P=0.002); previous health facility delivery (P<0.0001); first delivery in a health facility (P<0.0001); no history of a non-health facility delivery (P <0.0001); more than 50% of deliveries in a health facility (P=0.007); three or more antenatal care visits (P=0.031); above-average socio-economic status (P=0.016); living in a household of three or fewer individuals (P=0.028); living within 30 minutes? travel time of a health facility (P=0.007); and history of contraceptive use (P=0.046). These are the maternal determinants of health facility delivery in this rural setting. The mothers that delivered in health facilities were 15 and 29 years old (85.2%), either married or cohabiting (77.5%), had completed eight years or more of formal education (53.5%), lived within a radius of up to 30 minutes? journey from a health facility (67.2%) and lived in a household of four or more individuals (76.0%). This study shows that there are specific maternal characteristics (sociodemographic descriptors) that are associated with increased possibility of health facility delivery.

Bibliography: leaves 79-84. / Background: While there is a lot of literature available on the negative effects of orphanhood on children, litle attention has been paid to children in the period before their parents die when they are living with a sick parent. This study seeks to focus on such children to gain greater understanding of their situation. Aim: To describe the problems and coping strategies of children living with and caring for their terminally ill parents. Design: This study is a cross-sectional descriptive survey. Setting: A rural district in a middle-income country. Main outcome measures: Demography of households, symptoms of the sick parent, attributes of child carers, how children deal with specified symptoms of their parent's illness, greatest perceived hardships faced, type and quantity of help from outside sources and extended family. Results: Thirty five households were interviewed using a structured questionnaire. Households were found to be poor with difficulty accessing services. Most parents had symptoms consistent with AIDS and over 30% died within two months of the interview. Pain ranked as the most troublesome symptom. One hundred children aged four to eighteen were involved to some extent in the care of their sick parents. Male children were the main carers in 40% of households. The children generally dealt appropriately with the parents' symptoms and correcdy identified what pills they were taking and what the pills were for. Seventy one percent of carers believed that their parent would get better. The children identified their greatest hardships as hunger (43%), lack of money for school (29%) and parent's illness (19%). Sixty nine percent asked for material support and the same number reguested financial support for schooling. Support frum relatives was mostly provided by grandmothers and aunts. Five provided food, five cared for the sick person and three helped with child care. Ten of the 35 households were never visited by relatives staying outside the homestead. From the wider community, neighbours were the most supportive group practically, helping with food and nursing. Church groups were active in praying with families but most did not help materially or practically. Eight families received support from local non-governmental organisations and only two were visited by the Department of Welfare. Conclusions: Poverty was the overriding issue negatively impacting on the families. It prevented adequate access to health care, nutrition and schooling. Poor infrastructure and government services further compounded these problems as well as preventing access to water, sanitation, education and government grants. Children were often found to be caring for their parents with little external support and would benefit from training as well as supervision and counselling from trained health workers. The children's role as carers frequently interfered with school attendance yet many of their teachers were unaware of their home circumstances and did little to support them. Teachers' awareness of the social problems facing learners needs to be raised. Support by the extended family and community is often superficial and generally targets the sick parent while ignoring the children. Greater attention needs to be paid to the psychological and matenal needs of the children in these vulnerable families.

This study evaluates the input, process and output parameters of the Western Cape Developmental Screening Programme in order to inform policy and practice regarding developmental screening in the province. The study describes the background, development and implementation of the screening programme and examines its current delivery, including the main enabling factors and barriers to implementation. In order to achieve the abovementioned objectives, a combination of predominantly qualitative and some quantitative data was gathered in stages from all levels of the health system (provincial, regional and district levels) using a number of different methods. In addition to documentary and literature reviews, information was gathered via structured interviews with key health managers at a provincial and regional level, a rapid facility survey and facility based assessments. Information gathered from interviews and focus groups was analysed thematically, while rapid facility survey results were analysed via Epilnfo. Despite numerous successes in its development and the overall awareness of the Developmental Screening Programme, developmental screening is not conducted uniformly across the province. Almost a quarter of primary health care facilities do not deliver any aspect of the programme and only one of nine facilities deliver according to protocol. This study concludes that despite the Developmental Screening Programme being a well-conceptualised and highly valued programme, its delivery has failed as a result of constraints within the broader health system. As previous evaluations of child health programmes have demonstrated, the overall transformation of the health system, organisation of service delivery at a primary health care level and gaps in human resource development and information systems impact significantly on the delivery of preventive service delivery for children. As official programmes for developmental screening are not conducted in any other provinces, the study results may also inform policy and practice on a national level.

Thesis (M.S.)--Boston University

The purpose of this study was to determine whether differences in health beliefs exist between participants attending worksite prenatal education classes and participants receiving only prenatal education self-help materials. A multiple treatment study was performed on a sample of convenience of 169 women enrolled in Fruit of the Loom's worksite prenatal education program. Group 1 subjects received class and materials while Group 2 subjects received materials only. Study participants were asked to complete an 18-item Likert scale questionnaire prior to enrolling in the program and again upon completion. Sixty-two subjects completed both the pre- and posttest questionnaires. Analysis of covariance comparing posttest scores between groups using the pretest score as a covariate revealed no significant difference. Results from t test analysis on the questionnaire items revealed significant change in three of the items concerning importance of prenatal care, knowledge of healthy food choices, and abstinence from smoking.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.

This dissertation reports on a formative evaluation of a high school sexuality education programme. The evaluation aimed to generate a greater understanding of pupils' attitudes to sexuality and insight into pupils' responses to a sexuality education programme. A qualitative method using focus groups was used. The groups comprised pupils, with programme staff acting as facilitators and observers. The foremost findings were that pupils had considerable understanding of many of the issues which the programme aims to teach them about. Pupils requested that the programme address issues of their concern, including lifeskills development. They expressed dislike of lectures, and requested the use of small group discussions. They also expressed the need for individual counselling under circumstances where the pupils could develop a trusting relationship with the counsellor. Pupils expressed difficulty communicating with their parents about sexuality, and distrust for their teachers in the role of counsellors or educators in this field. In conclusion, the evaluation yielded much information of potential use in development of the sexuality education programme, and recommendations are put forward. By basing a Family Planning Advisor at each school the pupils needs could be better addressed. Such an arrangement would allow the advisor to encourage parents and the wider community to participate in the programme. This type of broad approach appears to be a prerequisite for success in this field.

BACKGROUND: In the United States, racial and income disparities in maternity care outcomes are large and persistent. Research demonstrates that community doulas (specialized community health workers for pregnant, birthing and postpartum people) can improve maternal and infant outcomes. Despite this evidence, doulas have not yet been widely adopted in health services for low-income communities. One barrier to scale-up is understanding the costs and benefits of integrating doula services into maternity care payment systems. METHODS: An exploratory, sequential mixed methods study design was used to understand decision-maker perspectives on doulas in maternity care and apply these priorities to an economic evaluation of a randomized trial of enhanced doula support. 16 in-depth, semi-structured interviews with Medicaid, Accountable Care Organization (ACO) and maternity care decision makers in Massachusetts were conducted. Results from the qualitative study informed the design of an economic analysis of a pragmatic trial of doula support. A return on investment analysis, with a focus on areas of high financial impact and organized by segments of health care services was conducted. Program costs were analyzed using a micro-costing approach. Hospital data on health care costs and payments were used to calculate financial outcomes for both intervention and control groups. Sensitivity and sub-group analyses were developed to understand variations in impact for different populations, settings and doula program models. RESULTS: Decision-maker interviews revealed that health care organizations prioritize investments that promote improved population health, patient experience, cost reduction, and elimination of racial disparities in outcomes. Participants universally expressed interest in an analysis approach that provides information on return-on-investment outcomes, as well as the clinical and cost areas with the largest impact. The time frame of interest was primarily in the pregnancy and newborn episodes of care, with some participants expressing interest in longer term outcomes related to fewer first cesarean deliveries or preterm birth. The economic analysis found an 18% return on investment for the Best Beginnings for Babies doula intervention overall. Sensitivity analyses demonstrated the largest impact was for people with medical and social risk factors and for those who received at least 5 hours of prenatal home visits, as well as labor support. CONCLUSION: Medicaid and maternity care decision-makers are supportive of doula programs if they are affordable and can create cost savings. An economic analysis of the Birth Sisters Best Beginnings for Babies program found a positive return on investment, benefiting both health care payers and families. Community doula programs are a high-value innovation that should be reimbursed by Medicaid agencies. / 2021-09-25T00:00:00Z

This study explored the perceptions of parents and staff around the services offered to young children with disabilities in Special schools. Questionnaires were distributed to parents of young children with disabilities attending Special schools and to the professional staff working with these children. Six Special schools, under the auspices of the Western Cape Education Department and situated in the Cape Town Metropole, participated in the study. Questionnaires focused on the following themes: knowledge of disability, the nature and amount of contact enjoyed by staff and parents, the level of participation, consultation and decision making afforded to parents and staff and the extent to which parents and staff perceived that their needs were being met by the school. Findings highlighted a need among staff and parents for more knowledge around all issues of disability. This included information pertaining to disability as well as knowledge of the roles of various staff trained to work with the children. Parents voiced an additional need for information relating to their child's activities during a school day. Results also indicated insufficient contact between parents and staff This impacted on the level of consultation and decision making afforded to parents. It also affected the way in which staff viewed interaction with parents as well as their attitudes towards them. Differences in parents' and staff's perceptions of the extent to which the schools met the needs of parents varied from school to school. It appeared that meeting the emotional needs of parents of young children with disabilities by the schools needed particular attention. Socioeconomic factors appeared to influence responses, especially in areas around knowledge of disability and the amount of contact maintained by parents with the school. Even though many parents wished to participate more in their child's school activities, financial and social constraints were cited as factors preventing this. This study is relevant in a time when changes are being implemented in the Special Education system, particularly when a more meaningful involvement is being demanded of parents in all aspects of school affairs. Recommendations are thus aimed at empowering parents and staff, with a view to strengthening the partnership between parents of young children with disabilities attending Special schools and the staff working at these schools.

According to the U.S. Centers for Disease Control and Prevention (CDC), maternal death ratios are severely racially stratified as African American women face the most significant risk. Currently, Black women are four times more likely to die from pregnancy-related death in the United States than white women. Race disparities in maternal health outcomes may be exacerbated by the Covid-19 pandemic as preliminary research suggests that the pandemic's disproportionate impact on Black communities and existing concerns about Black women's medical treatment may indicate an increase in mortality within the next few years. Racial health disparities reflect the nation's flawed maternal healthcare system and highlight a need for alternative healthcare models, including the increased use of doulas, who provide physical, emotional, and educational support during pregnancy, childbirth, and postpartum. Research has shown that doula care effectively mitigates adverse perinatal outcomes for socially disadvantaged women and their infants. Black doulas have distinct knowledge and insights about how race operates in the maternity care system as birth workers who serve Black birthing women, however, there is little research illuminating their perspectives. The current study is a qualitative analysis of the perspectives of Black doulas on their experiences with birth work in the U.S. maternity health care system during the Covid-19 pandemic and beyond using a critical intersectional lens. Data consist of in-depth, semi-structured qualitative interviews with 11 Black doulas throughout the U.S. Interviews were transcribed with the aid of Otter.ai and coded and analyzed thematically using NVivo. The results yielded four overarching themes: Advocacy and Trust are Key Components of Doula Work, Barriers to Accessing Doula Services and a Need for New Hospital Policies, COVID-19 Worsened Restrictions on Doula Work, and Increased Distrust of Hospitals among Black Indigenous and People of Color (BIPOC). The final theme focused on the History of Racism in Reproductive Health affects the Quality of Care Today and included a sub-theme regarding the Prevalence of Dismissive and Abusive Care. This study expands existing knowledge of race inequalities in maternal health by contributing the experiences and perspectives of Black doulas, who are uniquely positioned to observe Black patients' treatment in maternity care. Findings demonstrate a need for medical institutions to address systemic racism within their policies and procedures and highlight actionable solutions proposed by doulas to mitigate existing injustices.