Search

Additional file 1: Baseline survey.

Background: Given the role that continued use of family planning (FP) by current users plays in increasing contraceptive prevalence rates (CPR), this research aims to measure method-specific continuation rates for fixed-site and community-based program interventions and to document reasons for discontinuation. Methods: This research compared discontinuation rates for clients initiating family planning through two types of strategies—services provided at existing health centers that provided regular, ongoing services, and “one-off” outreach services in communities. Data collectors surveyed consenting clients who were initiating a modern method, or reinitiating after a break of at least six months, and conducted a follow up survey after seven months. Results: Long acting reversible contraception (LARC) was more commonly initiated through outreach strategies than through fixed sites. LARC made up 65% of methods initiated through the outreach setting and 47% of those initiated through a fixed-site strategy. Continuation rates varied from 99% for intrauterine devices (IUDs) to 77% for injectables and were very similar between outreach and fixed-site strategies, with the exception of oral contraceptive pills (OCPs). Only 65% of outreach initiators continued using OCPs, compared to 84% of fixed-site initiators. Top reported reasons for discontinuation were side effects and little or no sexual relations. Conclusions: Project interventions allowed most women to continue with their chosen method of FP for the seven-month duration of the study whether initiated through fixed site or outreach strategies, showing promise in helping Senegal to increase its CPR. It is feasible to offer both LARC and short acting methods through outreach strategies. Further research into the sensitivity of demand to the price charged is needed.

Household preparedness can help save lives and curtail staggering losses from natural disasters around the world. Finding ways to promote preparedness has become urgent in developing countries, which bear an increasingly disproportionate share of losses. Social capital reflects the quality of human relationships and may provide a useful resource to encourage households to prepare before it is too late. This study examines the influence of social capital on three aspects of household disaster preparedness: awareness of protective measures, knowledge of evacuation procedures and familiarity with response agencies. Two theoretical approaches to social capital are considered at the household-level: 1) relational social capital reflects the resources embedded in personal networks and is defined by resource composition, resource diversity and kinship composition; and 2) community social capital refers to the features of social organization (e.g., networks, norms and social trust) that promote cooperation within a group. Government representatives, civil society organizations in charge of disaster preparedness and community and household characteristics are also posited to influence household preparedness. Key informant interviews and a 182-household survey in 6 villages in Dominica in the Caribbean were used to assess the influence of relational and community social capital for locally-relevant measures of the three aspects of household preparedness. Results were analyzed for each outcome using logistic regression. The study.s key findings support that social capital enhances household preparedness and that this influence is moderate to strong relative to other factors. The effects of relational and community social capital, however, are distinct and furthermore vary across aspects of preparedness. Moreover, only resource diversity and to some extent kinship composition prove valuable characteristics of social networks. Diverse and kin-centered networks are valuable for awareness of protective measures. Networks with more diversity further enhance knowledge of evacuation procedures. Community social capital, on the other hand, improves familiarity with response agencies. In addition to emphasizing the importance of relationships among people for disaster preparedness, this study provides much needed empirical evidence contrasting two widely-used approaches to social capital. Relational and community social capital correspond to different types of human interactions and have a different utility.

Background The private health sector is a primary source of curative care for childhood illnesses in many low- and middle-income countries. Therefore ensuring appropriate private sector care is an important step towards improving outcomes from illnesses like pneumonia, which is the leading infectious cause of childhood mortality worldwide. This study aimed to provide evidence on private sector care for childhood pneumonia in Uttar Pradesh, India, by simultaneously exploring providers’ knowledge and practices and caregivers’ experiences. Methods We conducted in-depth interviews with a purposive sample of 36 practitioners and 34 caregivers in two districts. Practitioners included allopathic doctors, AYUSH providers, and drug sellers. Caregivers were mothers of children under the age of five with symptoms consistent with pneumonia who had seen one of those practitioners. Interview transcripts were analyzed thematically. Results Caregivers were generally prompt in seeking care outside the home, but many initially favored local informal providers based on access and cost. Drug sellers were not commonly consulted for treatment. Formal providers had imperfect, but reasonable, knowledge of pneumonia and followed appropriate steps for diagnosis, though some gaps were noticed that were primarily related to lack of (or failure to use) diagnostic tools. Most practitioners prescribed antibiotics and supportive symptomatic treatment. Relational and structural factors encouraged overuse of antibiotics and treatment interruption. Caregivers often had a limited understanding of treatment but wanted rapid symptomatic improvements, frequently leading to sequentially consulting multiple providers and interrupting treatment when symptoms improved. Providers were confronted with these expectations and care-seeking patterns. Conclusions This study contributes in-depth evidence on private sector care for childhood pneumonia in UP. Achieving appropriate care requires an enriched perspective that simultaneously considers the critical role of provider-caregiver interactions and of the context in which they occur in shaping treatment outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2100-z) contains supplementary material, which is available to authorized users.