Thesis (M.S.)--Brigham Young University. Dept. of Sociology, 2008. / Includes bibliographical references (p. 29-35).

Maternal mortality is the leading cause of death among women in Nigeria, especially women aged between 15 and 19 years. This research examines the geography of maternal mortality in Nigeria and the role of cultural and religious practices, socio-economic inequalities, urbanization, access to pre and postnatal care in explaining the spatial pattern. State-level data on maternal mortality rates and predictor variables are presented. Access to healthcare, place of residence and religion explains over 74 percent of the spatial pattern of maternal mortality in Nigeria, especially in the predominantly Muslim region of northern Nigeria where poverty, early marriage and childbirth are at its highest, making them a more vulnerable population. Targeting vulnerable populations in policy-making procedures may be an important strategy for reducing maternal mortality, which would also be more successful if other socio-economic issues such as poverty, religious and health care issues are promptly addressed as well.

The purpose of this research was to demonstrate one way in which the analytical and creative components of policy can complement one another to provide insight for understanding emergent (developmental) and cooperative systems. As a case study, this research examined a perinatal regionalization project--a new health care delivery system--to determine how it might develop from this point in its history, i.e., what form it might take. The key questions were: how do we design a workable and significant system? How much is science; how much art? Given the emergent social nature of the system, a twofold approach was required. The first approach, analytically organized, used multiple perspectives in gathering information for policy planning and implementation. The second approach, process oriented, used a new form of Delphi as a creative, participatory decision technique to design a policy structure. Application of multiple perspectives to a prospective issue, combining them with the participatory approach of the decision Delphi and distinguishing methods appropriate for emergent policy systems were departures from previous research. Data collection involved content analysis, extensive interviewing, and participant observation. Analysis based on three perspectives, technical-rational (T), organizational (O), and personal (P), yielded distinct pictures of the emerging social technology of regionalized perinatal health care delivery. The T perspective emphasized the well-ordered approach to implementation and indicated some areas to reinforce and develop based on measured outcomes. The O perspective emphasized the network of interrelated roles, procedures, and reinforcements (sources of satisfaction). It noted junctures for making inroads into the existing system. The P perspective provided the most immediate grasp of the essential and unique world of the participants. It found that images serve as both compelling visions and forces for change characterized by this non-trivial uniqueness. Delphi found that systems structures can be generated endogenously. Analysis of the three perspectives found that each of the three requires a type of research appropriate to it. In fact, the elusive P perspective can be formulated experientially--a self-reflective type of research--and communicated creatively. Both enhance its value. Analysis also found that while the three are distinct, each adds a dimension to understanding that would be lost without it. They can be integrated as mutual contexts of each other. Analysis found that the form of communication is as important as the form of research. Non-traditional means are more appropriate. Analysis found that design considers form as system self-image, system boundary, and system control. These distinguish the new system from the old. The concept is quite different from implementation as a sequential process in policy.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilmet of the requirement fo rthe Degree of Masters of Public Health. April 2012 / Maternal health services have been receiving increasing attention internationally. The high rates of maternal and infant mortality throughout the world place a demand on health systems to prioritize maternal and child health care services. The constitution of South Africa recognizes reproductive health as a fundamental right (Republic of South Africa, 1995). However, the inability of South Africa to meet the Millennium Development Goals targets for maternal and child health increases the need for more studies to identify the reasons for a consistently high maternal mortality rate. The South African health system is based on district health system model which facilitates the delivery of primary health care and the appropriate referrals and admissions of patients. District hospitals, public and private community health centers and public primary health care clinics provide the first level of care to patients. Normal deliveries should take place at this level. Referrals are made to secondary and tertiary level of care. The maternity ward at Kuruman Hospital in the Northern Cape province of South Africa is overcrowded. There are concerns around the quality of care and over 80% of deliveries are normal, suggesting that they could take place at the primary health care clinics and community health centres in the district.

MSc (Med), Child Health Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand / Objective: To identify determinants for the utilisation of delivery services by pregnant women in Rwanda, considering individual and demographic, socioeconomic and health service factors. Design: A secondary data analysis of the third (2005) Rwandan Demographic Health Survey (RDHS III) was conducted. Women who had at least one live birth during the fiveyear period prior to the survey were included in the analysis. Bivariate and multivariate analyses were undertaken. Results: A total of 5235 participants fulfilled the study eligibility criteria and were included in the analysis. Although more than 90% of participants attended an antenatal service, only 30% delivered at a health facility. The predictors of a home delivery were higher parity (OR=5.01, 95% CI: 4.11-6.31 for parity of 6 or more), place of residence (OR=1.86, 95% CI: 1.55-2.23 for rural women), lower household wealth (OR=4.37, 95% CI: 3.43-5.56 for the poorest quintile), lower education level (OR=3.61, 95% CI: 2.73-4.76 for no education), none or one antenatal care visit (OR=3.62, 95% CI: 2.76-4.74 for one antenatal care visit) and the lack of antenatal counselling about pregnancy complications (OR=1.83, 95% CI:1.40-2.40). Conclusion Utilisation of maternal health services, particularly health facility delivery services, remains low in Rwanda. The promotion of at least four standard antenatal care visits, as well as efforts targeting specific risk groups, such as higher parity, rural and less educated women living in poorer households are critical if the country wishes to reduce maternal and neonatal mortality and morbidity.

Background: Maternity services in South Africa like in many developing countries remains a challenge. The high mortality and morbidity rates recorded in the confidential enquiries to maternal death (CEMD) reports in South Africa support a need for more studies to be done to improve maternal health services. Although clinical procedures are an integral part of the maternal health services, little is known about the current-status of clinical procedures performed in the maternity units of district hospitals and related resource utilisation. The apparently “free” maternity services at government hospitals involve substantial hidden and unpredicted costs, which is not quantified. Aims of the study: To describe the cost of the specific clinical procedures performed at the maternity unit of Thebe District Hospital. Methodology: This was a cross-sectional study design involving a retrospective record review of all maternity patient records for a one-month period in 2009. The month of September is mid-month for the financial year and was chosen as it is reflected a stable month in terms of financial performance. The costing aspect of this study was based on the National Health Reference Price List and UPFS. Data was analysed with NCSS software. Results: The study found that NVD was the main clinical procedures, which is in line with the district hospital package. The CS rate was within acceptable norm but a significant number of BBA is of concern and would require further exploration. The majority of the patients who delivered at this unit are black, unemployed and had no medical aid. Most of them arrived by ambulance although it was not clear whether these patients were coming directly from home or were referred by PHC clinics and CHCs. There were no maternal and perinatal mortality and morbidity during the study period. This study documented the direct cost of clinical procedures performed at a district hospital. The Human resources was the main cost driver. The calculated cost for this study was far lower than the costs prescribed in NHRPL for NVD and CS but higher than UPFS. This study highlighted the need for revising the UPFS. Conclusion: The research findings will inform the resource needs for performing specified clinical procedures in maternity section at the Thebe District Hospital and will hopefully be used as a benchmark for maternity sections at all district hospitals in Thabo Mofutsanyana District and elsewhere. It has provided reasonable indications about the costs of each procedure and evidence can be used to determine the costs of each procedure in various district hospitals in the country and worldwide. It can further be utilised to do proper planning for our district hospitals in the province and develop the scientific criteria for resource allocation.

Introduction: Despite the method existing for centuries, uses of crowdsourcing have been rising rapidly since the term was coined a decade ago. Crowdsourcing refers to ‘outsourcing’ a problem or task to a large group of people (i.e., a crowd) rapidly and cheaply. Researchers debate over definitions of crowdsourcing, and it is often conflated with mHealth, web 2.0, or data mining. Due to the inexpensive and rapid nature of crowdsourcing, it may be particularly amenable to health research and practice, especially in a global health context, where health systems, human resources, and finances are often scarce. Indeed, one of the dominant methods of health research prioritization uses crowdsourcing, and in particular, wisdom of the crowds. This method, called the Child Health and Nutrition Research Initiative (CHNRI) method, employs researchers to generate and rank research options which are scored against pre-set criteria. Their scores are combined with weights for each criterion, set by a larger, diverse group of stakeholders, to create a ranked list of research options. Unfortunately, due to difficulties in defining and assembling a group of stakeholders that would be appropriate to each exercise, 75% of CHNRI exercises to-date did not involve stakeholders, and therefore presented unweighted ranks. Methods: First, a crowdsourcing was defined through a literature review. Benefits and challenges of crowdsourcing were explored, in addition to ethical issues with crowdsourcing. A second literature review was conducted to explore ways in which crowdsourcing has been already used in health and global health. As crowdsourcing could be a potential solution to data scarcity or act as a platform for intervention in global health settings, but its potential has never been systematically assessed, a CHNRI exercise was conducted to explore potential uses of crowdsourcing in global health and conflict. Experts from both global health and crowdsourcing participated in generation and scoring ideas. This CHNRI exercise was conducted in-line with previously described steps of the CHNRI method for setting health research priorities. As three quarters of CHNRI exercises have not utilized a larger reference group (LRG) of stakeholders, and the public was cited as the most difficult stakeholder group to involve, we conducted a survey using Amazon Mechanical Turk, an online crowdsourcing platform, that involved an international group of predominantly laypersons who, in essence, formed a public stakeholder group, scoring the most common CHNRI criteria using a 5-point Likert scale. The resulting means were converted to weights that can be used in upcoming exercises. Differences in geographic location, and whether the respondents were health stakeholders were assessed through the Fisher exact test and Wilcoxon rank-sum test, respectively. The influence of other demographic characteristics was explored through random-intercept modelling and logistic regression. Finally, an example of a national-level CHNRI exercise, which is the largest CHNRI conducted to-date, exploring research priorities in child health in India is described. Results: A comprehensive definition of crowdsourcing is given, along with its benefits, challenges, and ethical considerations for using crowdsourcing, based on a literature review. An overview of uses of crowdsourcing in health are discussed, and potential challenges and techniques for improving accuracy, such as introducing thresholds, qualifiers, introducing modular tasks and gamification. Crowdsourcing was frequently used as a diagnostics or surveillance tool. The CHNRI method was not identified in the second literature review. In re-weighting the CHNRI criteria using a public stakeholder group, we identified differences in relative importance of the criteria driven by geographic location and health status. When using random-intercept modelling to control for geographic location, we found differences due to health status in many criteria (n = 11), followed by gender (n = 10), ethnicity (n = 9), and religion (n = 8). We used the CHNRI method to explore potential uses of crowdsourcing in global health, and found that the majority of ideas were problem solving or data generation in nature. The top-ranked idea was to use crowdsourcing to generate more timely reports of future epidemics (such as in the case of Ebola), and other ideas relating to using crowdsourcing for the surveillance or control of communicable disease scored highly. Many ideas were related to the United Nations’ Sustainable Development Goals (SDGs). Finally, a national-level exercise to set research priorities in child health in India identified differential priorities for three regions (Empowered Action Group and North Eastern States, Northern States and Union Territories, and the Southern and Western States). The results will be very useful in developing targeted programmes for each region, enabling India to make progress towards SDG 3.2. Conclusion: Crowdsourcing has grown exponentially in the past decade. Integrating gamification, machine learning, simplifying tasks and introducing thresholds or trustworthiness scores increases accuracy of results. This research provides recommendations for improvements in the CHNRI method itself, and for crowdsourcing, generally. Crowdsourcing is a rapid, inexpensive tool for research, and thus, is a promising data collection method or intervention for health and global health.

Thesis M. Med.(Family Medicine))University of Limpopo (Medunsa Campus), 2010. / The experience of child birth occurs in all cultures and is important for the continuation of a community. Beliefs related to pregnancy and child birth though usually harmless may at times be detrimental to the health and well being of women that may practice them. The adherence to such beliefs depends on the socio cultural background of individuals and the importance they place on their cultural practices. Aim and objectives The study aimed to explore the health beliefs regarding pregnancy and childbirth of women attending the antenatal clinic at Chawama Health Center in Lusaka Zambia. The main study objectives were to determine the demographic characteristics of the women and ascertain their beliefs regarding diet, behaviour and belief in the use of herbs during pregnancy, delivery and the post natal period. Methods A descriptive, cross-sectional survey was conducted. A 32 item questionnaire was administered to 294 women over a four week period by two research assistants, after obtaining informed consent. Results Results indicate that traditional beliefs were wide spread among the participants though few significant associations were demonstrated. Dietary beliefs that what is eaten could ix affect the progress of labor or the unborn child’s appearance or behaviour were popular. Negative behaviour such as quarrelling or infidelity was believed could lead to difficult labour or adverse outcomes. Herbs were generally believed to be useful for certain indications such as to assist labour or for ‘cleansing’ after miscarriage. Conclusion Health beliefs regarding pregnancy and child birth are an integral part of the community and to be discussed in order to have some influence on them. Continued dialogue is recommended though current clinic health education sessions and qualitative studies to explore other beliefs and myths that are arising out of new health concerns such as HIV.