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Young mothers often encounter stigma and discrimination, affecting their lives and that of their children. This paper explores stigma management strategies and their effectiveness for young mothers in rural Nigeria. Ten key informants and 24 young mothers were recruited from Ife-East in South-Western Nigeria. Data from semi-structured interviews showed that societal disapproval of pregnant teenagers and young mothers were common experiences. Women used a range of strategies to actively cope with stigma including: belief in predestination, avoidance, concealment, and cohabitation. These strategies could be seen as tools to mitigate negative stereotypes and discrimination. However, they also had the unintended consequences of compounding many young women’s difficult circumstances and exposing them to adverse outcomes, including gender-based violence, repeat pregnancies, poor mental health, and low uptake of services. The results show the need for policy frameworks to actively combat stigma by addressing the negative framing of early pregnancy and motherhood and promoting supportive environments for young mothers. Health professionals need to be trained to offer de-stigmatising services to encourage young mothers to seek help and reduce pre-existing inequities in access to services, and policies need to include measures that address the rights of young mothers and protect them from violence and abuse. [ABSTRACT FROM AUTHOR]

The UN’s Zero Tolerance Policy, which bans all relationships between UN staff and locals, portrays all relationships as exploitative, fails to account for nuances in these relationships and does not acknowledge the agency of local women or communities. This study uses community-based qualitative data from eastern DRC that shares narratives on a wide variety of consensual relationships between peacekeepers and local women. Our paper uses a data-driven approach, including a post-colonial feminist lens, and ideas of structural agency to provide an expanded definition of agency that invites readers to re-examine their views of women in conflict settings. Finally, we provide clear recommendations for the UN and other international non-governmental agencies on policies related to sexual exploitation and abuse. [ABSTRACT FROM AUTHOR]

Purpose: Being on dialysis is a traumatic situation particularly during adolescence. Therefore, adolescents must have self-care support according to their special needs. The goal of this study was to describe the adolescents´ self-care practices when they are on dialysis. This paper reports only the adolescents´ selfcare practices based on the health care team guidelines but adjusted to their beliefs and habits. Methods: The methodology of the study was interpretive phenomenology. In-depth interviews were conducted with 15 adolescents; Smith´s IPA procedure was used for data analysis. Results: Being on dialysis meant to the adolescents living in a different and broken world. Self-care practices included: 1) coexisting with the dialysis slavery or being attached to a machine day or night, 2) struggling with the maddening thirst experience, 3) Deciding what, when and how much food to eat, 4) taking care of an alien that helps to survive, 5) taking the medicines when feeling in need of them. Conclusion: The adolescents tried to care for themselves adjusting their care activities to the health team´s recommendations. However, they also adjusted those practices to their beliefs and habits, which allows them to live with dialysis in a less traumatic way. [ABSTRACT FROM AUTHOR]

This article traces the origin, sustenance and implications of a persistent rumour that is responsible for low measles mumps and rubella (MMR) vaccination uptake in the Somali diaspora in a number of countries across the globe. The rumour stipulates that the MMR vaccine – the silent shot – causes autism spectrum disorder (ASD). Although the association between MMR and ASD is non-causal, and various public health initiatives have promoted health information campaigns, the rumour continues to circulate in the Somali diaspora in many countries, including Sweden. This paper shows that there are valid reasons for this. The findings from this paper draw on a systematic scoping review and qualitative interview data from Sweden. The results show that the Somali community experiences higher than average rates of ASD compared to the general population. Moreover, ASD does not exist in the Somali language or their home country, is considered a Western disease that only affects Somali children in the diaspora, and is a highly stigmatised disease. Also, the Somali diaspora has had negative experiences with ASD diagnosis and care. The rumour has been sustained by the absence of an answer to their ASD fear and through active diaspora networks on social media. The network that surrounds the rumour has arguably further helped to create an epistemic community for a community whose concerns have been silenced. [ABSTRACT FROM AUTHOR]

Climate change is an important driver of migration, but little research exists on whether migrant communities in the U.S. identify climate change-related factors as reasons for migrating. In 2021, we conducted a multidisciplinary, collaborative project to better understand the nexus of climate change and immigrant health in the Atlanta area. This paper presents one arm of this collaboration that explored both the role of climate change in decisions to immigrate to Georgia and the ways that climate change intersects with other possible drivers of migration. First generation migrants from Latin America were recruited primarily through CPACS Cosmo Health Center and were invited to participate in an intake survey and an in-depth interview. Results were analyzed using descriptive statistics and thematic analysis. Findings suggest that while participants may not have explicitly identified climate change as a primary reason for migration, in both surveys and in-depth interviews, participants reported multiple and intersecting social, economic, political, and environmental factors that are directly or indirectly influenced by climate change and that are involved in their decisions to migrate. The narratives that emerged from in-depth interviews further contextualised survey data and elucidated the complex nexus of climate change, migration, and health. [ABSTRACT FROM AUTHOR]

Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower – and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18–75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict. [ABSTRACT FROM AUTHOR]

Global health practitioners and policymakers have become increasingly vocal about the complex challenges of identifying and quantifying the causes of death of the world's poorest people. To address this cause-of-death uncertainty and to minimise longstanding sensitivities about full autopsies, the Bill and Melinda Gates Foundation have been one of the foremost advocates of minimally invasive autopsy technology (MIA). MIA involves using biopsy needles to collect samples from key organs and body fluids; as such, it is touted as potentially more acceptable and less invasive than a complete autopsy, which requires opening the cadaver. In addition, MIA is considered a good means of collecting accurate bodily samples and can provide the crucial information needed to address cause-of-death uncertainty. In this paper, we employ qualitative data to demonstrate that while MIA technology has been introduced as a solution to the enduring cause-of-death uncertainty, the development and deployment of technologies such as these always constitute interventions in complex social and moral worlds; in this respect, they are both the solutions to and the causes of new kinds of uncertainties. We deconstruct the ways in which those new dimensions of uncertainty operate at different levels in the global health context. [ABSTRACT FROM AUTHOR]

The probability of a single access point (AP) failure is very small. In addition, APs communicate with each other; therefore, it is considered that these failures have little impact on the wireless network. Only when a large number of APs are abnormal offline, do we consider that the wireless network is faulty and needs to be recovered immediately. Network breakdown, network congestion, and AP management software shutdown may cause numerous APs in aborted status. In this article, we utilize DBSCAN algorithm to detect abnormal Wi-Fi APs. Compared with other research works, our proposed unsupervised method can distinguish between normal and abnormal offline APs. This study proposes a new date dimension to calculate the number of online APs together with the time dimension, and it provides new insights to set up thresholds of online APs automatically. Experimental results show that this 3-D model based on date and time is more accurate than the traditional 2-D model only based on time. With regard to the sampling method of random forest, this paper carries out repetitive random sampling to form small sample sets and finally to obtain the mean feature plane, which can reduce the interference of abnormal points to our algorithm. [ABSTRACT FROM AUTHOR]

Attribute-level sentiment element extraction aims to obtain the word pair < opinion target, opinion word > from texts, which mainly obtain fine-grained evaluation information in the attribute level. Due to the information fragmentation and semantic sparseness of product reviews, it is difficult to capture more comprehensive local information from unstructured texts, which leads to the incorrect extraction of some word pairs. Aimed at the problem, this paper proposes a framework for Attribute-Level Sentiment Element Extraction (ALSEE) towards product reviews. Firstly, a small amount of sample data is selected by random sampling, and multiple features (including part of speech, word distance, dependency relationship and semantic role) which are labelled. The labelled data are used as the training set. Then, the Condition Random Field (CRF) model is applied to extract opinion targets (OT) and opinion words (OW). The self-training strategy is used to achieve the semi-supervised learning of CRF model through iterative training. Finally, target-opinion word pairs with modifying relationship are obtained by dependency parsing. Compared with the existing methods, the proposed framework can effectively extract attribute-level sentiment elements though experimental results. [ABSTRACT FROM AUTHOR]

Classical continuous goodness-of-fit (GOF) testing is employed for examining whether the data come from an assumed parametric model. In many cases, GOF tests assume a uniform null distribution and examine extreme values of the order statistics of the samples. Many of these statistics can be expressed by a function of the order statistics and the p-values amount to a joint probability statement based on the uniform order statistics. In this paper, we utilize Steck's recursion method and propose two high precision computing algorithms to compute the p-values for these GOF statistics. The numerical difficulties in implementing Steck's method are discussed and compared with solutions provided in high precision libraries. [ABSTRACT FROM AUTHOR]

This paper reports on the design of a study to examine the policy landscape relevant to sugar-sweetened beverage taxation in seven sub-Saharan African countries. The study responds to the need for strong policy to address the rising burden of non-communicable diseases in the region. Sugar-sweetened beverage taxation has been widely recommended as a key component of a comprehensive policy approach to NCD prevention. However, it has proved a contentious policy intervention, with industry strongly opposing the introduction of such taxes. The aim was to identify opportunities to strengthen sugar-sweetened beverage taxation-related policy for the prevention of nutrition-related NCDs in a subset of Eastern and Southern African countries: Kenya, Tanzania, Botswana, Rwanda, Namibia, Zambia, Uganda. The study was conducted as a collaboration by researchers from nine institutions; including the seven study countries, South Africa, and Australia. The research protocol was collabora-tively developed, drawing on theories of the policy process to examine the existing availability of evidence, policy context, and stakeholder interests and influence. This paper describes the development of a method for a policy landscape analysis to strengthen policies relevant to NCD prevention, and specifically sugar-sweetened beverage taxation. This takes the form of a prospective policy analysis, based on systematic documentary analysis supplemented by consultations with policy actors, that is feasible in low-resource settings. Data were collected from policy documents, government and industry reports, survey documentation, webpages, and academic literature. Consultations were conducted to verify the completeness of the policy-relevant data collection. We analysed the frames and beliefs regarding the policy 'problems', the existing policy context and understandings of sugar-sweetened beverage taxation as a potential policy intervention, and the political context across relevant sectors, including industry interests and influence in the policy process. This study design will provide insights to inform public health action to support sugar-sweetened beverage taxation in the region. [ABSTRACT FROM AUTHOR]

Background: While research on trans People of Color's experiences has been increasing in recent years, this intersectional work has often not included a focus on the specificities of multiracial and multiethnic trans experiences. Aims: This study explores shifts in racial identity by multiracial/multiethnic trans people as they transition gender and the ways Whiteness and nationalist ideology shape their racialized gender experiences. Methods: This paper is based on six in-depth, semi-structured interviewswith self-identifiedmultiracial, multiethnic, andmulti-heritage trans people in the USA. Data collection centered participants' experiences of self-identification and interactionswith others (e.g., family, acquaintances, and strangers). Results: As participants transitioned gender and were acknowledged by others in their gender identity, shifts in their embodiment were used by others to ascribe a new racialized gender. This often resulted in participants reflecting on their sense of self and racialized gender identities in new ways. Discussion: Multiracial and multiethnic transgender people's experiences in transitioning race confirm the importance of intersectional analysis, reveal the intersectional fluidity of social categories, explicate how social understandings of one category (e.g., race) influence another category (e.g., gender), demonstrate that the meanings associated with racialized gender are based in relations of power, and show that, in transgender studies particularly, we must attend to the ways that the concept of transition implicates not only gender, but also other categories such as race and nationality. [ABSTRACT FROM AUTHOR]

Ranked set sampling (RSS) design as a cost-effective sampling is a powerful tool in situations where measuring the variable of interest is costly and time-consuming; however, ranking information about sampling units can be obtained easily through inexpensive and easy to measure characteristics at little or no cost. In this paper, we study RSS data for analysis of an ordinal population. First, we compare the problem of non-representative extreme samples under RSS and commonly-used simple random sampling. Using RSS data with tie information, we propose non-parametric and maximum likelihood estimators for population parameters. Through extensive numerical studies, we investigate the effect of various factors including ranking ability, tie generating mechanisms, the number of categories and population setting on the performance of the estimators. Finally, we apply the proposed methods to the bone disorder data to estimate the proportions of patients with osteopenia and osteoporosis status. [ABSTRACT FROM AUTHOR]

Attribute-level sentiment element extraction aims to obtain the word pair < opinion target, opinion word > from texts, which mainly obtain fine-grained evaluation information in the attribute level. Due to the information fragmentation and semantic sparseness of product reviews, it is difficult to capture more comprehensive local information from unstructured texts, which leads to the incorrect extraction of some word pairs. Aimed at the problem, this paper proposes a framework for Attribute-Level Sentiment Element Extraction (ALSEE) towards product reviews. Firstly, a small amount of sample data is selected by random sampling, and multiple features (including part of speech, word distance, dependency relationship and semantic role) which are labelled. The labelled data are used as the training set. Then, the Condition Random Field (CRF) model is applied to extract opinion targets (OT) and opinion words (OW). The self-training strategy is used to achieve the semi-supervised learning of CRF model through iterative training. Finally, target-opinion word pairs with modifying relationship are obtained by dependency parsing. Compared with the existing methods, the proposed framework can effectively extract attribute-level sentiment elements though experimental results. [ABSTRACT FROM AUTHOR]

Communication tower (CT) and its accessory equipment (AE) such as radio frequency equipment (RFE) and antenna, are essential in providing highspeed and stable mobile network services. It is necessary to routinely monitor the security and stability of CT and AE for seamless communication. There is limited research on fine segmentation of communication base station objects. This paper proposes a method for accurately segmenting the point cloud of the CT and AE from Terrestrial Laser Scanning (TLS) data. At first, the CT point cloud is accurately segmented based on region growing and Random Sample Consensus (RANSAC). Then, the point cloud of pole-shaped apart is extended to a certain distance to obtain the buffer point cloud containing AE. Normal Differential (ND) clustering is employed to obtain several groups of clusters containing planes, and calculate each plane's filling rate and size. Finally, the cluster type (such as antenna, RFE, or other) is distinguished. The experimental results demonstrate that the point-based average F1-score of CTs is 98. 70%, the point-based and object-based average F1-scores of antennas are 96. 09% and 97. 93%, and the corresponding values for the RFE are 89. 89% and 90. 00%, respectively, indicating the optimal performance of the proposed method. [ABSTRACT FROM AUTHOR]

Although white stork Ciconia ciconia counts go back to the XIX century, making the species a model in population investigations, substantial gaps remain in the knowledge of its large-scale population dynamics. In particular, incomplete past estimates from the core breeding areas leave the long-term changes uncertain. In this paper, we provide the earliest estimation of population size and spatial distribution of the white stork in its main stronghold (Poland) to reconstruct the species long-term trends. Based on original survey data collected during the 2nd (1958, incomplete in Poland) and 3rd (1974, successful) International White Stork Census (IWSC) we compared stork numbers in a random sample of villages surveyed on both occasions. We applied linear models to estimate the population growth rate between 1958 and 1974 and to assess spatial variation in population change across the country. Finally, we collated worldwide stork numbers obtained from all IWSCs and discuss the long-term population trends in light of new data. The stork population in Poland in 1958 was estimated at 46,100 breeding pairs and the nationwide density at 14.7 pairs/100 km2. A strong decline (by 30.2%, 1.88% per year) was noted between 1958 and 1974 across Poland with prominent spatial variation reflecting differences in local densities. The strongest declines in absolute terms affected the most abundant populations in Eastern Poland. Our data show that in the mid-20th century, the stork population in Poland was close to the current level, but it experienced a massive decline during the 1960s–1980s. This decline was consistent with trends in the worldwide and regional European populations, contrary to earlier statements indicating limited, if any, changes in the core European area. Overall, our data expand knowledge on the long-term dynamics in the white stork numbers and show that even massive changes may easily go undetected if based on non-solid data. [ABSTRACT FROM AUTHOR]

Unintended pregnancy is a common global public health problem associated with significant health risks and social costs with 85 M occurring in 2012. Innumerable health surveys have shown increased contraceptive use and access, despite not meeting demand leading to unmet need for contraception. This paper scrutinizes inequity in unmet need among married women of reproductive age using PMA2020/Kenya survey data. Cross-sectional design with multi-stage cluster random sampling technique involving random selection of nine Counties, 120 enumeration areas and 42 households was adopted. Face-to-face interviews using digital platform was done in seven survey rounds from 2014 to 2018 generating 35,185 interviews. Strongly balanced panel data with 2,154 respondents per wave was analyzed using Stata® Ver 14.2. Unmet need was high amongst pubescents (23.2%), higher parity (22.6%), rural residency (22.6%), informal education (36.0%) and poorest (24.8%). Concentration index was negative (−0.11, SE = 0.01), implying poor households have unmet need unlike rich households. Unadjusted and adjusted odds ratio was estimated to rise by 0.44 (95%CL = 0.35–0.57, p-value < 0.05) and 0.69 times (95%CL = 0.34–1.42, p-value > 0.05) with increased poverty levels. Creating contraceptive uptake demand must reciprocate unfailing supply of inexpensive methods targeting adolescents, higher parity, less educated and poorest. Consider involving spouses when discussing contraceptive methods, associated side effects and individual health concerns. [ABSTRACT FROM AUTHOR]

In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and increase the affordability and accessibility of safe abortion and family planning have contributed to significant improvements in maternal mortality and other sexual and reproductive health (SRH) outcomes. The Trump administration's Global Gag Rule (GGR) – which prohibits foreign non-governmental organisations (NGOs) from receiving US global health assistance unless they certify that they will not use funding from any source to engage in service delivery, counselling, referral, or advocacy related to abortion – threatens this progress. This paper examines the impact of the GGR on civil society, NGOs, and SRH service delivery in Nepal. We conducted 205 semi-structured in-depth interviews in 2 phases (August–September 2018, and June–September 2019), and across 22 districts. Interview participants included NGO programme managers, government employees, facility managers and service providers in the NGO and private sectors, and service providers in public sector facilities. This large, two-phased study complements existing anecdotal research by capturing impacts of the GGR as they evolved over the course of a year, and by surfacing pathways through which this policy affects SRH outcomes. We found that low policy awareness and a considerable chilling effect cut across levels of the Nepali health system and exacerbated impacts caused by routine implementation of the GGR, undermining the ecology of SRH service delivery in Nepal as well as national sovereignty. [ABSTRACT FROM AUTHOR]

This paper considers the estimation of parameters for the Poisson regression model in the presence of high, but imperfect multicollinearity. To mitigate this problem, we suggest using the Poisson Liu Regression Estimator (PLRE) and propose some new approaches to estimate this shrinkage parameter. The small sample statistical properties of these estimators are systematically scrutinized using Monte Carlo simulations. To evaluate the performance of these estimators, we assess the Mean Square Errors (MSE) and the Mean Absolute Percentage Errors (MAPE). The simulation results clearly illustrate the benefit of the methods of estimating these types of shrinkage parameters in finite samples. Finally, we illustrate the empirical relevance of our newly proposed methods using an empirically relevant application. Thus, in summary, via simulations of empirically relevant parameter values, and by a standard empirical application, it is clearly demonstrated that our technique exhibits more precise estimators, compared to traditional techniques – at least when multicollinearity exist among the regressors. [ABSTRACT FROM AUTHOR]

In low- and middle-income countries, there is scarcity of validated and reliable measurement tools for health facility management, and many interventions to improve primary health care (PHC) facilities are designed without adequate evidence base on what management practices are critical. This article developed and validated a scorecard to measure management practices at primary health care facilities under the performance-based financing (PBF) scheme in Nigeria. Relevant management practice domains and indicators for PHC facilities were determined based on literature review and a prior qualitative study conducted in Nigeria. The domains and indicators were tested for face validity via experts review and organized into an interviewer-administered scorecard. A stratified random sampling of PHC facilities in three States in Nigeria was conducted to assess the reliability and construct validity of the scorecard. Inter-rater reliability using inter-class correlation (ICC) (1, k) was assessed with one-way ANOVA. Exploratory factor analysis (EFA) was conducted to assess the construct validity, and an updated factor structure were developed. 32 indicators and 6 management practice domains were initially described. Ordinal responses were derived for each indicator. Data on the scorecard were obtained from 111 PHC facilities. The ICC of mean ratings for each team of judges was 0.94. The EFA identified 6 domains (Stakeholder engagement and communication; Community-level activities; Update of plan and target; Performance management; Staff attention to planning, target, and performance; and Drugs and financial management) and reduced the number of indicators to 17. The average communality of selected items was 0.45, and item per factor ratio was 17:6. Despite a few areas for further refinement, this paper presents a reliable and valid scorecard for measuring management practices in PHC facilities. The scorecard can be applied for routine supervisory visits to PHC facilities, and can help accumulate knowledge on facility management, how it affects performance, and how it may be strengthened. [ABSTRACT FROM AUTHOR]

This paper aims to develop a multiple deferred state sampling plan for a time-truncated life test if the lifetime of the item follows exponentiated half logistic distribution. The optimal parameters of the proposed plan, such as the number of successive lots required for making the decision whether to accept or reject the current lot, sample size, the rejection and acceptance numbers are obtained using two points approach. The implementation of the proposed plan is illustrated with examples. Tables are constructed for various combinations of consumer's and producer's risks. Comparison is also made with existing sampling plans under exponentiated half logistic distribution. [ABSTRACT FROM AUTHOR]

Purpose: Healthiness is constructed, in Western culture, as a moral ideal or supervalue. This paper will interrogate the assumption that health and the pursuit of healthiness is always and unquestionably positive, by exploring how discourses of health and freedom interact to reinforce the current inequalities and detract from social transformation. Method: Twenty young South African adults were interviewed about their understandings and experiences of health. These discussions were analysed using Foucauldian discourse analysis. Results: Participants constructed healthiness as facilitating the experience of freedom, while at the same time being dependent on a personal orientation towards freedom (as opposed to merely submitting to dominant health authorities). Freedom discourses also played a role in connecting health to neoliberal discourses idealizing economic productivity and hard work. Participants were able to construct a self that is active, productive, valuable, hopeful, and self-assured when talking about health using discourses of freedom. However, these discourses also functioned to moralise and idealise healthiness, which contributed to blaming poor health on its sufferers. Conclusion: Health/freedom discourses can further reinforce the neoliberal value of individual responsibility by constructing self-improvement and self-work as the solution to ill-health, thereby contributing to victim-blaming and weakening support for public health interventions. [ABSTRACT FROM AUTHOR]

Abortion stigma is experienced not only by women but also by providers and health professionals in a wide range of legal contexts. This paper analyses interviews with providers who work in the public health system in the Metropolitan Area of Buenos Aires, Argentina. A court ruling in 2012, FAL/12, changed the interpretation of abortion's legal status, clarifying the decriminalisation of abortion in cases of rape, and also requiring public policies and procedures to speed up access to legal abortion. Between 2014 and 2017, we conducted 27 in-depth, semi-structured interviews with abortion providers in public facilities across healthcare services in the Metropolitan Area of Buenos Aires. We found the way that health providers dealt with abortion stigma evolved over the course of time, as the abortion debate moved from the margins to the heart of political debate and public policies in Argentina between 2007 and 2017. Providers' experiences changed as the social and legal context changed. FAL/12 – as a clear, legal ruling – was a landmark and turning point in the way health professionals in public health facilities conduct their activities, making it possible for them to move from providing silent and hidden abortion care, to acknowledging it with pride. [ABSTRACT FROM AUTHOR]

Disability encompasses the limitations on an individual’s basic physical activities, and the consequent social oppressions such individual faces in society. In this regard, the limitation on the use of some parts of the genitals in a patriarchal system is considered a form of disability. This paper describes the perceptions of and the coping mechanisms employed by affected couples dealing with the consequences of female genital mutilation (FGM) as a form of sexual disability. Cultural Libertarianism was employed as a theoretical framework. The paper presents the results of a descriptive cross-sectional study conducted in Akure, Ondo State, Nigeria, with 10 male and 12 female respondents purposively selected through a snowball sampling for in-depth interviews. The findings present the justifications provided for the practice of FGM, and victims’ perceptions of how it affects their sexual relations. Furthermore, it highlights coping strategies employed by affected women and their spouses. The study shows that the disabling consequence of FGM is largely sexual in nature, leading to traumatic experiences and negative beliefs about sex, and requiring a myriad of coping strategies employed by the disabled women, and their spouses, which may have its own implications for marital and sexual bliss. [ABSTRACT FROM PUBLISHER]

Background: Improving maternal health is a major development goal, with ambitious targets set for high-mortality countries like Bangladesh. Following a steep decline in the maternal mortality ratio over the past decade in Bangladesh, progress has plateaued at 196/100,000 live births. A voucher scheme was initiated in 2007 to reduce financial, geographical and institutional barriers to access for the poorest. Objective: The current paper reports the effect of vouchers on the use of continuum of maternal care. Methods: Cross-sectional surveys were carried out in the Chattogram and Sylhet divisions of Bangladesh in 2017 among 2400 women with children aged 0–23 months. Using Cluster analysis utilisation groups for antenatal care, facility delivery and postnatal care were formed. Clusters were regressed on voucher receipt to identify the underlying relationship between voucher receipt and utilisation of care while controlling for possible confounders. Results: Four clusters with varying levels of utilisation were identified. A significantly higher proportion of voucher-recipients belonged to the high-utilisation cluster compared to non-voucher recipients (43.5% vs. 15.4%). For the poor voucher recipients, the probability of belonging to the high-utilisation cluster was higher compared to poor non-voucher recipients (33.3% vs. 6.8%) and the probability of being in the low-utilisation cluster was lower than poor non-voucher recipients (13.3% vs. 55.4%). Conclusion: The voucher programme enhanced uptake of the complete continuum of maternal care and the benefits extended to the most vulnerable women. However, a lack of continued transition through the continuum of maternal care was identified. This insight can assist in designing effective interventions to prevent intermittent or interrupted care-seeking. Programmes that improve access to quality healthcare in pregnancy, childbirth and the postnatal period can have wide-ranging benefits. A coherent continuum-based approach to understanding maternal care-seeking behaviour is thus expected to have a greater impact on maternal, newborn and child health outcomes. [ABSTRACT FROM AUTHOR]

Background: Understanding the magnitude of inequalities and drivers for reducing gender-related health inequalities is crucial in developing countries. This is particularly the case for Liberia with its very high level of gender-related inequalities in health and health outcomes. Objective: This paper assesses the magnitude of gender health inequalities and the relative contribution of different factors to health inequality in Liberia. Methods: Data came from the Liberian Household Income Expenditure Survey 2014. A two stage sampling methodology was used and 4,104 households were randomly selected and interviewed. The main variable of interest is dichotomised, good versus poor self-assessed health. Gender-related health inequality is assessed using the Oaxaca–Blinder decomposition for non-linear models. The decomposition reveals the magnitude of inequality and contributions of different factors. Results: We found large gender disparities (0.054, p < 0.01) characterised by women disadvantages in health status. In addition, the gender health disparities are mostly pronounced in rural areas. About 54% of the gender inequalities in health status were explained by the differences in endowments. Equalizing access to information, wealth and utilization of mosquito nets would reduce the gender gaps by 44, 5 and 4%, respectively. Conclusions: Addressing gender health inequalities inter alia requires access to health information (i.e. electronic and print media), gender responsive interventions that improve wealth in key sectors (i.e. education, employment, social protection, housing, and other appropriate infrastructure). In addition, the government, private sector and civil society should ensure that the health sector provides access to quality mosquito nets and improved health services including preventive care in order to reduce disease burden. [ABSTRACT FROM AUTHOR]

The efficiency of a statistic determines its efficacy. In stratified random sampling, many estimators for the population mean has been proposed. In this paper, we propose two new estimators both of which are combined ratio/product estimators. We refer to our estimators as mixture estimators. We derive the mean square errors (MSEs) up to the first order. A comprehensive simulation study was carried out to show the effectiveness of our estimators as compared to the conventional estimators that utilize auxiliary information. We also compared the performance of our estimators and some of the more popular competing estimators using real data. Both the simulations and real data analysis showed our estimators were more efficient than almost all existing estimators considered. [ABSTRACT FROM AUTHOR]

This paper proposed an improved generalized class of estimator for estimating population variance using auxiliary variables based on simple random sampling without replacement. The expression of mean square error of the proposed estimator is obtained up to the first order of approximation. We have derived the conditions for the parameters under which the proposed estimator performs better compared to the usual estimator and other existing estimators. An empirical study and simulation study are also carried out with the support of theoretical results. [ABSTRACT FROM AUTHOR]

In simple random sampling setting, the ratio estimator is more efficient than the mean of a simple random sampling without replacement (SRSWOR) if ρyx > 1/2 Cx/Cy, provided R > 0, which is usually the case. This shows that if auxiliary information is such that ρyx < -1/2 Cx/Cy, then we cannot use the ratio method of estimation to improve the sample mean as an estimator of population mean. So there is need for another type of estimator which also makes use of information on auxiliary variable x. Product method of estimation is an attempt in this direction. Product-type estimators are widely used for estimating population mean when the correlation between study and auxiliary variables is negatively high. This paper is developed to the study of the estimation of the population mean using of unbiased dual to product estimator by incorporating robust modified maximum likelihood estimators (MMLE's). Their properties have been obtained theoretically. For the support of the theoretical results, simulations studies under several super-population models have been made. We study the robustness properties of the modified estimators. We show that the utilization of MMLE's in estimating finite population mean results to robust estimates, which is very gainful when we have non-normality or common data anomalies such as outliers. [ABSTRACT FROM AUTHOR]

Background: Worldwide, there is an increased reliance on casual staff in the health sector. Recent policy attention in South Africa has focused on the interrelated challenges of agency nursing and moonlighting in the health sector. Objective: This paper examines the potential health system consequences of agency nursing and moonlighting among South African nurses. Methods: During 2010, a cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses providing clinical care completed a self-administered questionnaire after giving informed consent. The questionnaire obtained information on socio-demographics, involvement in agency nursing and moonlighting, and self-reported indicators of potential health system consequences of agency nursing and moonlighting. A weighted analysis was done using STATA® 13. Results: In the survey, 40.7% of nurses reported moonlighting or working for an agency in the preceding year. Of all participants, 51.5% reported feeling too tired to work, 11.5% paid less attention to nursing work on duty, and 10.9% took sick leave when not actually sick in the preceding year. Among the moonlighters, 11.9% had taken vacation leave to do agency work or moonlighting, and 9.8% reported conflicting schedules between their primary and secondary jobs. In the bivariate analysis, moonlighting nurses were significantly more likely than non-moonlighters to take sick leave when not sick (p=0.011) and to pay less attention to nursing work on duty (p=0.035). However, in a multiple logistic regression analysis, the differences between moonlighters and non-moonlighters did not remain statistically significant after adjusting for other sociodemographic variables. Conclusion: Although moonlighting did not emerge as a statistically significant predictor, the reported health system consequences are serious. A combination of strong nursing leadership, effective management, and consultation with and buy-in from front-line nurses is needed to counteract the potential negative health system consequences of agency nursing and moonlighting. [ABSTRACT FROM AUTHOR]

Background: Staff retention and turnover have risen in prominence in the global discourse on the health workforce. Moonlighting, having a second job in addition to a primary job, has not featured in debates on turnover. Objective: This paper examines whether moonlighting is a determinant of South African nurses' intention to leave their primary jobs. Design: During 2010, a one-stage cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information and information on moonlighting, the questionnaire obtained information on the participants' intention to leave their primary jobs in the 12 months following the survey. A weighted analysis of the survey data was done using STATA® 13. Results: Survey participants (n=3,784) were predominantly middle-aged with a mean age of 41.5 (SD±10.4) years. Almost one-third of survey participants (30.9%) indicated that they planned to leave their jobs within 12 months. Intention to leave was higher among the moonlighters (39.5%) compared to non-moonlighters (27.9%; p<0.001). Predictors of intention to leave in a multiple logistic regression were moonlighting in the preceding year, nursing category, sector of primary employment, period working at the primary job, and number of children. The odds of intention to leave was 1.40 (95% CI: 1.16-1.69) times higher for moonlighters than for non-moonlighters. The odds ratio of intention to leave was 0.53 (95% CI: 0.42-0.66) for nursing assistants compared to professional nurses and 2.09 (95% CI: 1.49-2.94) for nurses working for a commercial nursing agency compared to those working in the public sector. Conclusions: Moonlighting is a predictor of intention to leave. Both individual and organisational strategies are needed to manage moonlighting and to enhance retention among South African nurses. [ABSTRACT FROM AUTHOR]

In this paper, a two-stage dispatching rule for the on-time delivery of an order-driven FAB is presented. Dispatching rules have a significant impact on the performance of FABs. Consequently, many such rules have been created, such as first in first out, earliest due data, operation due date, and critical ratio. Because these conventional dispatching rules make decisions only by considering the due date of each lot, they might not be suitable for dynamic order-driven FABs, for which it is very essential to monitor not only the due date of each lot but also the production rate of each step. In the first stage of the proposed two-stage dispatching rule, the production rate of each step is taken into account, and the due date of each lot is considered in the second stage. In this paper, the production rates of steps are computed by combining forward simulation and backward pegging. A simulation model, based on a wafer FAB data-set, has been developed, and simulation is conducted using commercial software SEEPLAN®. The simulation results clearly show the advantages of the proposed dispatching rule over existing rules. [ABSTRACT FROM PUBLISHER]

In recent times, parents have become increasingly concerned, both subjectively and objectively, about their adolescents' body height/weight growth. Parent-adolescent interactions about this issue and the potential socio-psychological consequences of such interactions should be considered as an important influencing factor on the future of adolescents' sexual and reproductive health. To achieve a greater understanding of such concerns, it is necessary to further elucidate parents' experiences on this topic, so as to expand the existing literature. This study aimed to explain the perceptions of parents' concerns regarding their adolescents' growth characteristics in the socio-cultural context of Iran as a transitional society. This paper is part of a larger qualitative study designed using the Constructivist Grounded Theory Methodology (CGTM). We conducted open-ended intensive interviews with eleven parents individually and recruited them through purposeful and theoretical sampling from a teaching hospital, community, and a primary school in Tehran with theoretical sampling variation in terms of teenagers' age, sex, and birth order, place of residence, parents' occupation and education, and the self-reported socio-economic status. Using the analytical procedures of the CGTM, we performed analyses. In the findings, the concept of 'living with constant sense of uncertainty' emerged from the subcategories including 'feeling existing and potential concern about expected minimum and maximum bio-positions of growth,' 'feeling potential concern about biological health consequences,' 'feeling potential concern about the emergence of early/late maturity signs,' 'feeling potential concern about adolescent's emotional threat,' 'feeling concerned about future employment, education, marriage, and fertility,' and 'feeling potential concern about the society's view'. These findings suggest that parents are living with a constant sense of uncertainty about their teens' growth characteristics throughout the transition from adolescence. All stakeholders including parents, health-care practitioners and policymakers, and anthropologists/sociologists should be focus on such concerns, in order to manage them and their possible socio-psychological burdens. [ABSTRACT FROM AUTHOR]

Purpose: Although social capital influences health-related decisions and behavioural patterns in many developing countries, minimal attention has been paid to the nuances of its effect on healthcare. This paper examines how bonding social capital affects healthcare delivery for inpatients in Ghana. Methods: Semi-structured in-depth interviews were used and thematic analysis method employed to analyse the data. Interviews were conducted with health professionals and relatives and close friends of inpatients in three public health facilities in Ashanti region. Results: Relatives and close friends of inpatients were a critical source of instrumental support such as provision of meals, laundry services, running errands and financial assistance as well as emotional support. These functions—that were both 'expected' and 'encouraged'— reduced the burden on the health facilities, which apparently had limited resources to offer adequate care. However, the relatives of inpatients sometimes inadvertently obstructed efficient healthcare delivery through actions such as extending 'unapproved' alternative care to patients. Moreover, the process of contributing towards health and well-being of the sick exposed the relatives to health risks due to poor living conditions. Conclusion: A well-defined and befitting role must be devised for at least an immediate social relation of inpatients to improve the positive effects of bonding social capital on healthcare delivery. [ABSTRACT FROM AUTHOR]

This article interrogates the mainstream healthcare narrative that frames human immunodeficiency virus (HIV) as a chronic disease, and triangulates it with the lived experiences of people with HIV in Singapore. It also examines how HIV patients reconstruct their identities after the diagnosis of HIV. Four HIV patients (two males and two females) were interviewed in depth by an experienced medical social worker. Findings revealed that even as the illness trajectory of HIV has shifted from a terminal condition to a chronic one, living with HIV continues to be fraught with difficulty as society, especially in the Asian context, perceives HIV with much fear and disapproval. The participants had an overwhelming sense of shame when they were initially diagnosed with HIV and they had to reconstruct a liveable identity by containing the shroud of shame, reinforcing their normative identities and constructing new ones. These strategies help them to keep their shame at bay. This paper also unpacks nuanced insights of shame experienced by Chinese HIV patients in an Asian city dominated by Confucian values. [ABSTRACT FROM AUTHOR]

This paper examines the use of a randomization-based activity to introduce the ANOVA F-test to students. The two main goals of this activity are to successfully teach students to comprehend ANOVA F-tests and to increase student comprehension of sampling distributions. Four sections of students in an advanced introductory statistics course participated in this study. When the topic of ANOVA was introduced, two sections were randomly assigned to participate in a traditional approach (one for each instructor), while the other two sections participated in a randomization-based method. Students were administered a pre-test and a post-test that asked them to apply hypothesis testing concepts to a new scenario. Students also responded to some basic conceptual questions. This study showed mixed results related to students' understanding of the logic of inference, but the activity utilized shows some promising gains in student understanding of sampling distributions. [ABSTRACT FROM AUTHOR]

There is global emphasis on transforming health workforce education in support of universal health coverage. This paper uses a social accountability framework, specifically the World Health Organization's six building blocks for transformative education, to explore key informants' perspectives on nursing education in South Africa. Using a snowballing sampling technique, 44 key informants were selected purposively on the basis of their expertise or knowledge of the research area. Semi-structured interviews were conducted with the key informants after informed consent had been obtained. The interviews were analysed using template analysis. South Africa has strategic plans on human resources for health and nursing education, training, and practice and has a well-established system of regulation and accreditation of nursing education through the South African Nursing Council (SANC). Key informants criticised the following: the lack of national staffing norms; sub-optimal governance by both the SANC and the Department of Health; outdated curricula that are unresponsive to population and health system needs; lack of preparedness of nurse educators; and the unsuitability of the majority of nursing students. These problems are exacerbated by a perceived lack of prioritisation of nursing, resource constraints in both the nursing education institutions and the health training facilities, and general implementation inertia. Social accountability, which is an essential component of transformative education, necessitates that attention be paid to the issues of governance, responsive curricula, educator preparedness, and appropriate student recruitment and selection. [ABSTRACT FROM AUTHOR]

Worldwide, there is an increased reliance on casual staff in the health sector. Recent policy attention in South Africa has focused on the interrelated challenges of agency nursing and moonlighting in the health sector. This paper examines the potential health system consequences of agency nursing and moonlighting among South African nurses. During 2010, a cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses providing clinical care completed a self-administered questionnaire after giving informed consent. The questionnaire obtained information on socio-demographics, involvement in agency nursing and moonlighting, and self-reported indicators of potential health system consequences of agency nursing and moonlighting. A weighted analysis was done using STATA® 13. In the survey, 40.7% of nurses reported moonlighting or working for an agency in the preceding year. Of all participants, 51.5% reported feeling too tired to work, 11.5% paid less attention to nursing work on duty, and 10.9% took sick leave when not actually sick in the preceding year. Among the moonlighters, 11.9% had taken vacation leave to do agency work or moonlighting, and 9.8% reported conflicting schedules between their primary and secondary jobs. In the bivariate analysis, moonlighting nurses were significantly more likely than non-moonlighters to take sick leave when not sick (p=0.011) and to pay less attention to nursing work on duty (p=0.035). However, in a multiple logistic regression analysis, the differences between moonlighters and non-moonlighters did not remain statistically significant after adjusting for other socio-demographic variables. Although moonlighting did not emerge as a statistically significant predictor, the reported health system consequences are serious. A combination of strong nursing leadership, effective management, and consultation with and buy-in from front-line nurses is needed to counteract the potential negative health system consequences of agency nursing and moonlighting. [ABSTRACT FROM AUTHOR]