88 results on '"Schellenberg JA"'
Search Results
2. Evidence to improve maternal and newborn health: The IDEAS Project
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Becker, AJ and Schellenberg, JA
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An overview leaflet of the project: it's aims, learning questions and evaluation methods.
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- 2013
3. Economic modelling for evaluation of complex interventions to improve maternal & newborn health
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Mangham-Jefferies, L, Mills, A, Cousens, S, and Schellenberg, JA
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Background: Economic evaluation estimates the cost-effectiveness of interventions in a given setting. The extent to which economic evaluation can guide policy and programme decisions depends on whether results can be generalised beyond the study setting. When interventions are complex, as they often are in low-income countries, and target behaviour change or health system strengthening, the assumptions about the context, intensity and scale of implementation are especially important and affect the generalisability of cost-effectiveness results.\ud \ud Design and methods: The IDEAS project aims to learn about the efficiency of complex interventions to improve maternal and neonatal health implemented by grantee organizations in Ethiopia, North-Eastern Nigeria and Uttar Pradesh in India. The interventions are wide-ranging, though aim to increase the number and quality of interactions between families and frontline workers, and improve the survival of mothers and newborns. An economic model is being developed to provide a framework that can be applied across the three settings.\ud \ud Results: Research is ongoing. In developing the model we will depict the relationship between behaviour change and health system initiatives, interactions between families and frontline workers, the maternal and neonatal health care received, and expected health outcomes. We aim to incorporate contextual factors, and also the intensity and scale of implementation. The model will bring together data from primary and secondary sources. Sensitivity analysis will be undertaken.\ud \ud Conclusions: The research will explore the potential for economic modelling to draw lessons about the cost-effectiveness of complex interventions to improve maternal and neonatal health across multiple settings.
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- 2012
4. Measuring Implementation Strength Literature Review: Possibilities for maternal and newborn health programmes
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Avan, BI and Schellenberg, JA
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Measuring the strength of programme implementation is an emerging evaluation approach to help to understand: a) the predictability of outcomes and impact of proven interventions, b) why some programmes are more successful than others, and c) how changes in outcomes can be attributed to a particular programme. However, there is a lack of consensus about what are the most efficient approaches, including statistical techniques to generate implementation strength scores for a given health intervention or programme.\ud \ud In order to address this knowledge gap, we carried out a systematic literature review with the following aims: a) what conceptual frameworks have been used to identify components of implementation strength scores in the scientific literature and b) what types of epidemiological and statistical techniques have been employed to measure implementation strength scores in programmatic settings\ud \ud The review included evidence from peer reviewed journal databases and seminal grey literature. Data was extracted independently by three reviewers into a structured form. 2,297 titles and abstracts were examined. After studying the full texts of 184 documents, 26 studies were selected for the review. The studies included were from mental health, chronic care, primary care, public service, health promotion, public health, and education disciplines.\ud \ud The review found that a range of scaling and scoring systems are used to measure quantity and quality of implementation. Commonly used components of implementation strength score were organizational structure e.g., leadership, human resources, information systems, and processes of services delivery, e.g. activities, types, availability, and quality of services. However, there was no uniform approach in defining and measuring implementation. Finally, the review suggests a lack of rigorous evidence for measuring large-scale implementation of complex interventions in low income countries.
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- 2012
5. Data Informed Platform for Health Feasibility Study Report, \ud Uttar Pradesh, India
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Schellenberg, JA, Gautham, M, Avan, BI, IDEAS, London School of Hygiene & Tropical Medicine, and Public Health Foundation of India
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The implementation of a new tool, the Data Informed Platform for Health, could be feasible in Uttar Pradesh, India, according to a new report published by IDEAS today. The report describes the findings of a feasibility study undertaken in Uttar Pradesh, India. The Data Informed Platform for Health (DIPH) is a framework to guide coordination, bringing together key data from public and private health sectors on inputs and processes that could influence maternal and newborn health. The key data will be synthesised to create a measure of programme implementation strength for each local area, which in turn can be used in the evaluation of the effects of large-scale programmes on health outcomes.
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- 2012
6. Data Informed Platform for Health Feasibility Study Report, \ud Gombe State, Nigeria
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Schellenberg, JA, Avan, BI, IDEAS, and Health Hub Ltd
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IDEAS has published a report on the feasibility of implementing the Data Informed Platform for Health in Gombe State, Nigeria. The Data Informed Platform for Health (DIPH) is a framework to guide coordination, bringing together key data from public and private health sectors on inputs and processes that could influence maternal and newborn health. The key data will be synthesised to create a measure of programme implementation strength for each local area, which in turn can be used in the evaluation of the effects of large-scale programmes on health outcomes.
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- 2012
7. Measuring implementation strength: Literature review draft report 2012
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Schellenberg, JA, Bobrova, N, and Avan, BI
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Measuring implementation strength (sometimes referred to as implementation intensity) is an important programme evaluation process which helps to understand why some programmes are successful and some fail, attribute outcomes to a programme, and anticipate outcomes of future programmes. Implementation data can also help in evaluating and improving progress toward specific outcomes and intervention strategies. In developing a new approach, the ‘District Evaluation Platform’, to evaluate large-scale effectiveness for proven interventions at a national level it is important to measure implementation strength as “insufficient implementation is a common reason for absence of impact”. Nevertheless, despite the importance of evaluating implementation strength of complex, multidimensional interventions, scientific evidence devoted to this issue is limited, especially in low income countries.
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- 2012
8. Methodological approaches to evaluation of complex interventions in maternal and newborn health: IDEAS project
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Hill, Z, Allen, E, Avan, BI, Berhanu, D, Gautham, M, Mangham-Jefferies, L, Makowiecka, K, Marchant, T, Rechel, B, Schellenberg, JA, Spicer, N, and Kumar, N
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education ,health care economics and organizations - Abstract
The IDEAS project aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. IDEAS uses measurement, learning and evaluation to find out what works, why and how in maternal and newborn health. IDEAS is funded between 2010 and 2015 by a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. This poster outlines the reseach objectives and how research questions will be addressed.
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- 2012
9. Evidence to improve maternal and newborn health in Ethiopia, North-Eastern Nigeria and Uttar Pradesh, India
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Schellenberg, JA
- Abstract
IDEAS is a 5 year measurement, learning and evaluation (MLE) project funded by the Bill & Melinda Gates Foundation. The goal is to find out what works, why and how for maternal and newborn health (MNH) programmes in Ethiopia, North-East Nigeria and Uttar Pradesh, India. The project aims to (1) build local capacity for MLE, (2) measure efforts to increase the coverage of critical interventions through enhancing interactions between families and frontline workers, (3) explore scale-up of MNH innovations, (4) investigate the impact on survival of MNH innovations implemented at scale, and (5) promote best practice for policy. IDEAS will test the theory that improved newborn & maternal survival can be achieved at scale by enhancing interactions between families and frontline workers so that the coverage of critical interventions is increased. An innovative component of IDEAS is to use the District Evaluation Platform approach which generates an implementation strength score to measure the scale-up of MNH innovations across the 3 geographies.\ud \ud Results from early data collection by IDEAS will be presented, with a focus on measuring the coverage of critical interventions and existing interactions between families & frontline workers in NE Nigeria prior to the widespread implementation of Foundation funded MNH innovations. In May 2012 a linked household, frontline worker and health facility survey using cluster sampling was implemented across Gombe State. Forty enumeration areas were selected with probability proportional to size and all households within those clusters surveyed. All household heads and resident women aged 13-49 were interviewed to investigate the frequency and quality of interactions between families and frontline workers, the baseline coverage of critical interventions for mothers and newborns, and how equitably interactions and interventions were distributed. Frontline workers and primary level health facilities were surveyed to capture supply side indicators of service quality.\ud \ud These results will provide important demand and supply side evidence about maternal and newborn health care in an area with a very high mortality burden, and will form the basis for understanding future priorities in NE Nigeria.
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- 2012
10. Inequities among the very poor: health care for children in rural southern Tanzania.
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Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H, Bryce J, and Tanzania IMCI MCE Baseline Household Survey Study Group
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- 2003
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11. Impact on malaria morbidity of a programme supplying insecticide treated nets in children aged under 2 years in Tanzania: community cross sectional study.
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Abdulla S, Schellenberg JA, Nathan R, Mukasa O, Marchant T, Smith T, Tanner M, and Lengeler C
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- 2001
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12. An analysis of the geographical distribution of severe malaria in children in Kilifi District, Kenya.
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Schellenberg, JA, Newell, JN, Snow, RW, Mung'ala, V, Marsh, K, Smith, PG, Hayes, RJ, Schellenberg, J A, Newell, J N, Snow, R W, Smith, P G, and Hayes, R J
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Background: Although malaria is known to be a major cause of child mortality and morbidity throughout sub-Saharan Africa there are few detailed studies of malaria mortality rates and incidence of severe malarial disease in defined communities. We have studied the geographical pattern of admissions to hospital with severe malaria and the stability of this pattern over time in Kilifi District on the Kenyan Coast.Methods: Over a 2-year period all children under 5 years of age with severe malaria admitted to the district hospital and living in a rural study population of about 50,000 people were identified. Annual censuses were carried out in the study area, and all households were mapped using a hand-held satellite navigation system. The resulting databases were linked using a geographical information system (GIS).Results: Using methods originally developed for the study of the geographical distribution of childhood leukaemia we assessed the spatial pattern of hospital admission rates for severe malaria. As expected, admission rates were significantly higher in children with easier access to the hospital. For example, those living more than 25 km from the hospital had admission rates which were about one-fifth of those for children living within 5 km of the hospital. Those living more than 2.5 km from the nearest road had admission rates that were about half of those for children living within 0.5 km of a road. We also investigated short-term local fluctuations in severe malaria and found evidence of space-time clustering of severe malaria.Conclusions: Hospital admission rates for severe malaria are higher in households with better access to hospital than in those further away. The finding of space-time clusters of severe malaria suggests that it would be of value to conduct case-control studies of environmental, genetic and human behavioural factors involved in the aetiology of the disease. [ABSTRACT FROM AUTHOR]- Published
- 1998
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13. District decision-making for health in low- and middle-income countries: assessing the feasibility of a data-informed platform for health through multi-country studies
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Avan, Bi, Wickremasinghe, D, Berhanu, D, Umar, N, Gautham, M, Schellenberg, Ja, and Bhattacharyya, S
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Innovative approaches are needed to improve the effectiveness of data use for planning and decision-making in district health systems. This panel discusses the feasibility of a data-informed platform for health in India, Ethiopia and Nigeria, considering decision-making tools and processes, public and private sector data, data flow and sharing.
14. Evidence to improve maternal and newborn health in Ethiopia, North East Nigeria and Uttar Pradesh, India
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Marchant, T, Hill, Z, Mangham-Jefferies, L, and Schellenberg, JA
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health care economics and organizations - Abstract
IDEAS aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. IDEAS uses measurement, learning and evaluation to find out what works, why and how in maternal and newborn health. IDEAS is funded between 2010 and 2015 by a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. One research question is"Do enhanced interactions lead to increased coverage of interventions?"
15. A content analysis of district level health data in Uttar Pradesh, India
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Avan, BI, Schellenberg, JA, Bhattacharya, S, Wickremasinghe, D, Srivastava, A, and Gautham, M
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The study aimed to conduct a content analysis of the different types of public health data maintained by the Health Department, the Department of Women and Child Development, and the private for profit and not for profit health sectors and the links that exist between them in terms of data sharing. \ud Method: In two districts, Sitapur and Unnao, an IDEAS/PHFI study team visited district, sub-district and village level health facilities (public and private) as well as NRHM programme management units, and Women and Child Development offices. The team collected all available forms and interviewed facility staff and programme managers to understand the types of data collected, their flow and data sharing. Case studies of three \ud not-for-profit non-governmental organisations were developed to understand how they maintain and share data with the public health system. \ud Findings: The public health system collects a large volume of health data; Data exist for all of WHO’s health system building blocks, but it is unevenly distributed. There are fewer data on contextual information, e.g. village infrastructure and demographic profile, compared to service delivery; There is little formal or institutional routine data sharing between the public and private health sectors, and between the health department and other related departments such as Women and Child Development.
16. Measuring skilled attendance at birth using linked household, health facility, and health worker surveys in Ethiopia, North-East Nigeria, and Uttar Pradesh, India
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Marchant, T and Schellenberg, JA
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Background: The measurement of key intervention coverage to improve maternal health is complex. Large scale household surveys provide high-quality estimates of the number of women who have skilled attendance at birth, but most provide little or no detail about the quality of care women receive. For example, information on the preparedness of the skilled birth attendant to manage labour is not included. Here we describe measurement of key intervention coverage for mothers using linked household data, health facility and health worker data.\ud \ud Methods: In 2012, linked household, health facility and health worker survey data were collected to ascertain the relationship between women having interactions with health workers, and the population level coverage of key interventions for mothers and newborns. Data from each source was linked at the level of the household cluster: sub-villages. All women living in the sub-village were interviewed with a special module for women who had a birth in the previous 12 months. The health facility providing services to these women was surveyed to determine preparedness to provide care, and frontline health workers in the village were interviewed. The number and quality of interactions taking place, and the extent to which this translated into coverage of key interventions, was explored.\ud \ud Findings: Health facility, health worker and household data were all needed to estimate the six intra-partum interventions that usually fall under the proxy indicator ‘skilled attendance at birth’. Data is presented to illustrate measurement complexities, and the gap between coverage of skilled birth attendance, quality of care, and the coverage of the six key intra-partum interventions.\ud \ud Interpretation: Measurement across the continuum of care requires linking multiple data collection approaches. Developing methods to unpack key interventions for mothers, and for their newborns, is of critical importance to develop strategies for improved survival.
17. Impact evaluation of public health strategies in low and middle-income settings. Measuring implementation strength: why and how?
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Schellenberg, JA, Goodman, C, Avan, BI, Davey, C, and Hargreaves, JR
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Weak health systems are a common feature of low and middle income settings, and the 'know-do� gap between proven health interventions and routine practice is particularly wide. Evaluation of programmes seeking to narrow the gap is needed, to fuel both course-correction and impact evaluation.\ud \ud For both implementers and evaluaters, questions of interest include: which packages of individual evidence-based interventions can be delivered at scale? How to optimise these packages in a new setting? To what extent to these result in public health gains?\ud \ud Large-scale public health programmes are often set in a rapidly-changing context. Randomised trials are often unfeasible or answer other questions rather than those given above. A plausibility design based on a comparison of changes over time in both intervention and comparison areas may be able to answer the questions, but untouched comparison areas rarely exist. One alternative is to measure the strength or intensity with which packages of interventions are delivered, with a view to exploring the association between implementation strength and public health gains.\ud \ud Advantages and disadvantages of using implementation strength within large-scale programme evaluations will be discussed. Drawing from three published examples in low- and middle-income settings, we show how implementation strength has been used in health programme evaluation, and discuss when the approach might be counter-productive.
18. Where there’s ‘willingness’ there’s a way: barriers and facilitators to maternal, newborn and child health data sharing by the private health sector in Uttar Pradesh, India
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Gautham, M, Spicer, N, Srivastava, A, Bhattacharya, S, Avan, BI, and Schellenberg, JA
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In India and Uttar Pradesh (UP), the private health sector plays an important role in health care services, including institutional deliveries, but there is limited information on the availability of maternal, newborn and child health (MNCH) data that private facilities maintain and share with the public health information system. Sharing data could help the public sector plan their resources more efficiently.\ud Aim of the study: To explore current practices of MNCH data availability and sharing/reporting by private health facilities and the barriers and facilitators to data sharing.
19. Knowledge into action: using research findings to inform policies in maternal and newborn health
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Spicer, N, Schellenberg, JA, and Rechel, B
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Background: Many interventions found to be effective in research studies on maternal and newborn health and survival, fail to translate into policies and health service delivery models in settings with high maternal and newborn morbidity and mortality. IDEAS is a 5-year project funded by Bill & Melinda Gates Foundation, in three areas with high burden of maternal and neonatal mortality: Ethiopia, North-Eastern Nigeria and Uttar Pradesh in India. The project is a multi-method evaluation of complex interventions in maternal and newborn health (MNH), and is implemented by the London school of Hygiene & Tropical Medicine. One of the objectives of the project is to assess the extent to which innovative MNH care models are scaled up and to identify enabling and inhibiting factors to scale up. As part of this assessment we have undertaken a qualitative study to explore how research findings and knowledge generated in pilot projects are used by policy makers in developing policies and strategies for MNH. \ud \ud \ud \ud Methods\ud \ud Building on frameworks for transferring knowledge into action (Lavis et al 2009; Darmschroder et al 2009), we developed a topic guide seeking to explore views of researchers, policy makers and other stakeholders on translating research findings into policy. A total of about 75 in-depth interviews are being undertaken in Ethiopia, Nigeria and India. The topic guide is used as a flexible tool allowing participants to express opinions and raise issues that are most relevant to them. The interviews are recorded and transcribed verbatim. The transcripts are analysed by a team of researchers from London and the three countries, using framework analysis for policy research. This abstract presents emerging findings from pilot interviews in Ethiopia and India. \ud \ud \ud \ud Findings\ud \ud Willingness of policy makers to consider research findings depends to a great extent on how they perceive the quality of the evidence: whether it is conducted by an independent organisation, whether it is statistically significant and whether health outcomes could be attributed to particular components of complex, multi-layered programmes. The way evidence is disseminated influences the likelihood of its uptake into policy. It is more likely to be considered if it is presented by people who had legitimacy (experts in the field); if the audience included high level decision makers and donors who had the authority to act on the data; and if it included demonstartion sites (taking decision makers to the field to get emotional buy-in. \ud \ud \ud \ud Interpretation \ud \ud Translation of research evidence into policy depends on 1) the nature of the evidence and how the strength and validity (independence) of the evidence is perceived; 2) the way research is communicated: by whom (messenger), to whom (audience) and how (vehicle); 3) the ability and willingness of decision-makers to use evidence depending on capacity and context. \ud \ud \ud \ud References\ud \ud Damschroder LJ, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50. \ud \ud \ud \ud Lavis JN, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). Introduction. Health Research Policy and Systems 2009, 7(Suppl 1):I1
20. The IDEAS Project: evaluating complexity in maternal and newborn health in Ethiopia, Nigeria and India
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Schellenberg, JA
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A presentation given by Project Principal Investigator Professor Joanna Schellenberg to the School's Centre for Evaluation.\ud \ud Outline\ud •Background, motivation\ud •Objectives, research questions\ud •Selected methods and results\ud •Technical Resource Centre\ud •Who we are\ud •Highlights and challenges
21. Barriers to scale-up and diffusion: findings from a multi-country study
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Spicer, N, Schellenberg, JA, and Becker, AJ
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Background: There is growing interest among funders about how to deliver effective health programmes at scale with finite budgets. While there is a rich conceptual literature on scale-up and diffusion of innovations, few empirical studies have been conducted on health programmes in low-income settings, meaning assumptions about scale-up are largely untested. We present findings from a multi-country qualitative study exploring scale-up of demand and supply-side innovations in maternal and newborn health in Ethiopia, India and Nigeria. The aims are to: (1) identify and understand major factors enabling/inhibiting scale-up of these innovations; (2) evaluate the effectiveness of mechanisms for catalysing and enabling their scale-up.\ud \ud The study is part of IDEAS (Informed Decisions for Actions to improve maternal and newborn health), a five-year measurement, learning and evaluation project led by the London School of Hygiene and Tropical Medicine and funded by the Bill & Melinda Gates Foundation.\ud \ud Methods: We developed a conceptual framework to structure data collection/analysis drawing on diverse disciplinary approaches including the diffusion of innovations literature, health policy analysis, and health systems and services research. In April-September 2012 we will carry out 225 in-depth/semi-structured interviews with government officials, development agencies, private sector stakeholders and civil society.\ud \ud Results: The paper will present study findings based on the 225 interviews. We expect multiple factors to explain (limited) scale-up: attributes of an innovation; decision makers’ political/ideological values and financial interests; capacities of implementers; geographical, economic and sociocultural determinants of community uptake; political, economic, technological, legal and institutional country contexts. We expect different mechanisms for catalysing scale-up to be effective in different settings including policy advocacy and appealing to opinion leaders to spread ideas through community networks. \ud \ud Conclusions: Evidence on scale-up health programmes is needed since concepts/theories remain largely untested.
22. The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania.
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Mrisho M, Obrist B, Schellenberg JA, Haws RA, Mushi AK, Mshinda H, Tanner M, Schellenberg D, Mrisho, Mwifadhi, Obrist, Brigit, Schellenberg, Joanna Armstrong, Haws, Rachel A, Mushi, Adiel K, Mshinda, Hassan, Tanner, Marcel, and Schellenberg, David
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Background: Although antenatal care coverage in Tanzania is high, worrying gaps exist in terms of its quality and ability to prevent, diagnose or treat complications. Moreover, much less is known about the utilisation of postnatal care, by which we mean the care of mother and baby that begins one hour after the delivery until six weeks after childbirth. We describe the perspectives and experiences of women and health care providers on the use of antenatal and postnatal services.Methods: From March 2007 to January 2008, we conducted in-depth interviews with health care providers and village based informants in 8 villages of Lindi Rural and Tandahimba districts in southern Tanzania. Eight focus group discussions were also conducted with women who had babies younger than one year and pregnant women. The discussion guide included information about timing of antenatal and postnatal services, perceptions of the rationale and importance of antenatal and postnatal care, barriers to utilisation and suggestions for improvement.Results: Women were generally positive about both antenatal and postnatal care. Among common reasons mentioned for late initiation of antenatal care was to avoid having to make several visits to the clinic. Other concerns included fear of encountering wild animals on the way to the clinic as well as lack of money. Fear of caesarean section was reported as a factor hindering intrapartum care-seeking from hospitals. Despite the perceived benefits of postnatal care for children, there was a total lack of postnatal care for the mothers. Shortages of staff, equipment and supplies were common complaints in the community.Conclusion: Efforts to improve antenatal and postnatal care should focus on addressing geographical and economic access while striving to make services more culturally sensitive. Antenatal and postnatal care can offer important opportunities for linking the health system and the community by encouraging women to deliver with a skilled attendant. Addressing staff shortages through expanding training opportunities and incentives to health care providers and developing postnatal care guidelines are key steps to improve maternal and newborn health. [ABSTRACT FROM AUTHOR]- Published
- 2009
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23. Implementation of community-level quality improvement in southeastern Tanzania : a mixed methods process evaluation of what worked, what didn't, and why
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Tancred, Tara, Marchant, T., and Schellenberg, Ja
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362.1982 - Abstract
Background: In Tanzania, maternal and newborn health outcomes have been slow to improve. The Expanded Quality Management Using Information Power (EQUIP) project was carried out in Tandahimba district from November 2011–April 2014. EQUIP engaged village volunteers in quality improvement processes in which they problem-solved around key issues related to maternal and newborn health in their communities. Examples of community-level quality improvement are rare and there is little documentation of these. Aim: To explore the implementation of community-level quality improvement in-depth, identifying its facilitators and barriers; to analyse community-level quality improvement within the context of community participation; to determine influencers of birth preparedness and health facility delivery; and to evaluate user perspectives around perceived quality of maternal and newborn health care. Methods: A mixed-methods process evaluation in four villages (November 2012– November 2013). A continuous household survey provided quantitative data around household behaviours and perceived quality of care. Results: Mentoring and coaching were required to strengthen volunteer capacities to do quality improvement. Support from village leaders, regular volunteer education, and use of local data were key facilitators of the intervention. Community participation was high with some indication of empowering processes. Volunteer-targeted practices like birth preparedness and health facility deliveries were carried out by a majority of women (95% and 68% respectively). Common reasons for these practices included education around their importance from multiple sources; feeling that making birth preparations would positively impact care received; and male involvement. Qualitative data highlighted instances of disrespectful or abusive care, suggesting improvements in quality of care are still needed. Conclusion: Village volunteers readily participated in EQUIP. With support, volunteers were able to use quality improvement to contribute positively to changing care-seeking and other behaviours around maternal and newborn health. However, improvements in care-seeking must be accompanied by improvements in quality of care.
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- 2016
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24. Does the Integrated Management of Childhood Illness cost more than routine care? Results from the United Republic of Tanzania.
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Adam T, Manzi F, Schellenberg JA, Mgalula L, de Savigny D, and Evans DB
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OBJECTIVE: The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually. Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care. Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania. METHODS: Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level. We also included administrative and support costs incurred by national and district administrations. The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size. FINDINGS: The annual cost per child of caring for children less than five years old in districts with IMCI was USD 11.19, 44% lower than the cost in the districts without IMCI (USD 16.09). Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI. Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts. CONCLUSION:IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania. Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI. Copyright © 2005 World Health Organization [ABSTRACT FROM AUTHOR]
- Published
- 2005
25. Applying an equity lens to child health and mortality: more of the same is not enough.
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Victora CG, Wagstaff A, Schellenberg JA, Gwatkin D, Claeson M, and Habicht J
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- 2003
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26. “These are not good things for other people to know”: How rural Tanzanian women’s experiences of pregnancy loss and early neonatal death may impact survey data quality.
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Haws RA, Mashasi I, Mrisho M, Schellenberg JA, Darmstadt GL, and Winch PJ
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Abstract: Little research in low-income countries has compared the social and cultural ramifications of loss in childbearing, yet the social experience of pregnancy loss and early neonatal death may affect demographers’ ability to measure their incidence. Ninety-five qualitative reproductive narratives were collected from 50 women in rural southern Tanzania who had recently suffered infertility, miscarriage, stillbirth or early neonatal death. An additional 31 interviews with new mothers and female elders were used to assess childbearing norms and social consequences of loss in childbearing. We found that like pregnancy, stillbirth and early neonatal death are hidden because they heighten women’s vulnerability to social and physical harm, and women’s discourse and behaviors are under strong social control. To protect themselves from sorcery, spiritual interference, and gossip—as well as stigma should a spontaneous loss be viewed as an induced abortion—women conceal pregnancies and are advised not to mourn or grieve for “immature” (late-term) losses. Twelve of 30 respondents with pregnancy losses had been accused of inducing an abortion; 3 of these had been subsequently divorced. Incommensurability between Western biomedical and local categories of reproductive loss also complicates measurement of losses. Similar gender inequalities and understandings of pregnancy and reproductive loss in other low-resource settings likely result in underreporting of these losses elsewhere. Cultural, terminological, and methodological factors that contribute to inaccurate measurement of stillbirth and early neonatal death must be considered in designing surveys and other research methods to measure pregnancy, stillbirth, and other sensitive reproductive events. [ABSTRACT FROM AUTHOR]
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- 2010
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27. Gaps in policy-relevant information on burden of disease in children: a systematic review.
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Rudan I, Lawn J, Cousens S, Rowe AK, Boschi-Pinto C, Tomaskovic L, Mendoza W, Lanta CF, Roca-Feltrer A, Carneiro I, Schellenberg JA, Polasek O, Weber M, Bryce J, Morris SS, Black RE, and Campbell H
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- 2005
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28. Improving antimicrobial use among health workers in first-level facilities: results from the Multi-Country Evaluation of the Integrated Management of Childhood Illness strategy.
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Gouws E, Bryce J, Habicht J, Amaral J, Pariyo G, Schellenberg JA, and Fontaine O
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OBJECTIVE: The objective of this study was to assess the effect of Integrated Management of Childhood Illness (IMCI) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities. Antimicrobial drugs are an essential child-survival intervention. Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives. Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance. METHODS: Data collected through observation-based surveys in randomly selected first-level health facilities in Brazil, Uganda and the United Republic of Tanzania were statistically analysed. The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness, cost and impact (MCE). FINDINGS: Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI.They are also more likely to receive the first dose of the drug before leaving the health facility, to have their caregiver advised how to administer the drug, and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility. CONCLUSIONS: IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries. Copyright © 2004 World Health Organization [ABSTRACT FROM AUTHOR]
- Published
- 2004
29. Getting it right for children: a review of UNICEF joint health and nutrition strategy for 2006-15.
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Bryce J, El Arifeen S, Bhutta ZA, Black RE, Claeson M, Gillespie D, Gwatkin DR, Habicht J, Jones G, Lanata CF, Morris SS, Mshinda H, Pariyo G, Perkin G, Schellenberg JA, Steketee RW, Troedsson H, and Victora CG
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- 2006
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30. Implementation pathway report: Uttar Pradesh Technical Support Unit, India, June 2015
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Girase, BA, Dwivedi, P, Srivastava, A, Bhattacharya, S, Avan, Bilal, Schellenberg, Ja, and Becker, Aj
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parasitic diseases - Abstract
The Implementation Pathway of the Technical Support Unit for Uttar Pradesh state (UP-TSU) was conducted with the aim of examining how the UP-TSU is being implemented in the broader contexts of maternal and newborn health programmes, health systems and the socio-cultural background in Uttar Pradesh state. Methodologically, it follows a standardised structure and format to describe the mechanisms of action and implementation details of the UP-TSU.
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- 2015
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31. Implementation of the 'Optimising the Health Extension Program' Intervention in Ethiopia: A Process Evaluation Using Mixed Methods.
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Okwaraji YB, Hill Z, Defar A, Berhanu D, Wolassa D, Persson LÅ, Gonfa G, and Schellenberg JA
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- Child, Ethiopia, Health Priorities, Humans, Program Evaluation, Counseling, Health Promotion, Patient Acceptance of Health Care
- Abstract
An intervention called 'Optimising the Health Extension Program', aiming to increase care-seeking for childhood illnesses in four regions of Ethiopia, was implemented between 2016 and 2018, and it included community engagement, capacity building, and district ownership and accountability. A pragmatic trial comparing 26 districts that received the intervention with 26 districts that did not found no evidence to suggest that the intervention increased utilisation of services. Here we used mixed methods to explore how the intervention was implemented. A fidelity analysis of each 31 intervention activities was performed, separately for the first phase and for the entire implementation period, to assess the extent to which what was planned was carried out. Qualitative interviews were undertaken with 39 implementers, to explore the successes and challenges of the implementation, and were analysed by using thematic analysis. Our findings show that the implementation was delayed, with only 19% ( n = 6/31) activities having high fidelity in the first phase. Key challenges that presented barriers to timely implementation included the following: complexity both of the intervention itself and of administrative systems; inconsistent support from district health offices, partly due to competing priorities, such as the management of disease outbreaks; and infrequent supervision of health extension workers at the grassroots level. We conclude that, for sustainability, evidence-based interventions must be aligned with national health priorities and delivered within an existing health system. Strategies to overcome the resulting complexity include a realistic time frame and investment in district health teams, to support implementation at grassroots level.
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- 2020
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32. Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India.
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Marchant T, Beaumont E, Makowiecka K, Berhanu D, Tessema T, Gautham M, Singh K, Umar N, Usman AU, Tomlin K, Cousens S, Allen E, and Schellenberg JA
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- Adult, Child Health Services statistics & numerical data, Ethiopia, Female, Health Services Accessibility statistics & numerical data, Humans, India, Infant, Newborn, Insurance Coverage statistics & numerical data, Maternal Health Services statistics & numerical data, Nigeria, Pregnancy, Rural Population statistics & numerical data, Socioeconomic Factors, Child Health Services standards, Health Services Accessibility standards, Maternal Health Services standards
- Abstract
Background: Despite progress toward meeting the Sustainable Development Goals, a large burden of maternal and neonatal mortality persists for the most vulnerable people in rural areas. We assessed coverage, coverage change and inequity for 8 maternal and newborn health care indicators in parts of rural Nigeria, Ethiopia and India., Methods: We examined coverage changes and inequity in 2012 and 2015 in 3 high-burden populations where multiple actors were attempting to improve outcomes. We conducted cluster-based household surveys using a structured questionnaire to collect 8 priority indicators, disaggregated by relative household socioeconomic status. Where there was evidence of a change in coverage between 2012 and 2015, we used binomial regression models to assess whether the change reduced inequity., Results: In 2015, we interviewed women with a birth in the previous 12 months in Gombe, Nigeria ( n = 1100 women), Ethiopia ( n = 404) and Uttar Pradesh, India ( n = 584). Among the 8 indicators, 2 positive coverage changes were observed in each of Gombe and Uttar Pradesh, and 5 in Ethiopia. Coverage improvements occurred equally for all socioeconomic groups, with little improvement in inequity. For example, in Ethiopia, coverage of facility delivery almost tripled, increasing from 15% (95% confidence interval [CI] 9%-25%) to 43% (95% CI 33%-54%). This change was similar across socioeconomic groups ( p = 0.2). By 2015, the poorest women had about the same facility delivery coverage as the least poor women had had in 2012 (32% and 36%, respectively), but coverage for the least poor had increased to 60%., Interpretation: Although coverage increased equitably because of various community-based interventions, underlying inequities persisted. Action is needed to address the needs of the most vulnerable women, particularly those living in the most rural areas., Competing Interests: Competing interests: None declared., (© 2019 Joule Inc. or its licensors.)
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- 2019
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33. Acceptability of malaria rapid diagnostic tests administered by village health workers in Pangani District, North eastern Tanzania.
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Mushi AK, Massaga JJ, Mandara CI, Mubyazi GM, Francis F, Kamugisha M, Urassa J, Lemnge M, Mgohamwende F, Mkude S, and Schellenberg JA
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- Caregivers, Cross-Sectional Studies, Female, Humans, Interviews as Topic, Male, Tanzania, Community Health Workers, Diagnostic Tests, Routine methods, Disease Management, Malaria diagnosis, Patient Acceptance of Health Care, Rural Population
- Abstract
Background: Malaria continues to top the list of the ten most threatening diseases to child survival in Tanzania. The country has a functional policy for appropriate case management of malaria with rapid diagnostic tests (RDTs) from hospital level all the way to dispensaries, which are the first points of healthcare services in the national referral system. However, access to these health services in Tanzania is limited, especially in rural areas. Formalization of trained village health workers (VHWs) can strengthen and extend the scope of public health services, including diagnosis and management of uncomplicated malaria in resource-constrained settings. Despite long experience with VHWs in various health interventions, Tanzania has not yet formalized its involvement in malaria case management. This study presents evidence on acceptability of RDTs used by VHWs in rural northeastern Tanzania., Methods: A cross-sectional study using quantitative and qualitative approaches was conducted between March and May 2012 in Pangani district, northeastern Tanzania, on community perceptions, practices and acceptance of RDTs used by VHWs., Results: Among 346 caregivers of children under 5 years old, no evidence was found of differences in awareness of HIV rapid diagnostic tests and RDTs (54 vs. 46 %, p = 0.134). Of all respondents, 92 % expressed trust in RDT results, 96 % reported readiness to accept RDTs by VHWs, while 92 % expressed willingness to contribute towards the cost of RDTs used by VHWs. Qualitative results matched positive perceptions, attitudes and acceptance of mothers towards the use of RDTs by VHWs reported in the household surveys. Appropriate training, reliable supplies, affordability and close supervision emerged as important recommendations for implementation of RDTs by VHWs., Conclusion: RDTs implemented by VHWs are acceptable to rural communities in northeastern Tanzania. While families are willing to contribute towards costs of sustaining these services, policy decisions for scaling-up will need to consider the available and innovative lessons for successful universally accessible and acceptable services in keeping with national health policy and sustainable development goals.
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- 2016
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34. Data Resource Profile: The sentinel panel of districts: Tanzania's national platform for health impact evaluation.
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Kabadi GS, Geubbels E, Lyatuu I, Smithson P, Amaro R, Meku S, Schellenberg JA, and Masanja H
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- Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Causality, Child, Child, Preschool, Data Collection methods, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Residence Characteristics, Sex Distribution, Socioeconomic Factors, Tanzania epidemiology, Young Adult, Public Health Surveillance methods, Vital Statistics
- Abstract
The Sentinel Panel of Districts (SPD) consists of 23 districts selected to provide nationally representative data on demographic and health indicators in Tanzania. The SPD has two arms: SAVVY and FBIS. SAVVY (SAmple Vital registration with Verbal autopsY) is a demographic surveillance system that provides nationally representative estimates of mortalities based on age, sex, residence and zone. SAVVY covers over 805 000 persons, or about 2% of the Tanzania mainland population, and uses repeat household census every 4-5 years, with ongoing reporting of births, deaths and causes of deaths. The FBIS (Facility-Based Information System) collects routine national health management information system data. These health service use data are collected monthly at all public and private health facilities in SPD districts, i.e. about 35% of all facilities in Mainland Tanzania. Both SAVVY and FBIS systems are capable of generating supplementary information from nested periodic surveys. Additional information about the design of the SPD is available online: access to some of SPD's aggregate data can be requested by sending an e-mail to [hmasanja@ihi.or.tz]., (© The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)
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- 2015
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35. Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial.
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Penfold S, Manzi F, Mkumbo E, Temu S, Jaribu J, Shamba DD, Mshinda H, Cousens S, Marchant T, Tanner M, Schellenberg D, and Schellenberg JA
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- Adolescent, Adult, Breast Feeding methods, Breast Feeding statistics & numerical data, Developing Countries, Directive Counseling methods, Female, Humans, Infant Care organization & administration, Infant Care statistics & numerical data, Infant, Newborn, Middle Aged, Outcome Assessment, Health Care, Perinatal Care methods, Perinatal Care organization & administration, Perinatal Care statistics & numerical data, Pregnancy, Surveys and Questionnaires, Tanzania, Young Adult, Community Health Workers, Directive Counseling organization & administration, Health Knowledge, Attitudes, Practice, House Calls, Infant Care methods, Rural Health Services organization & administration, Volunteers
- Abstract
Background: In Sub-Saharan Africa over one million newborns die annually. We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practices and survival. Here we report the effect on newborn care practices one year after full implementation., Methods: All 132 wards in the 6-district study area were randomised to intervention or comparison groups. Starting in 2010, in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practices including hygiene, breastfeeding and identification and extra care for low birth weight babies. In 2011, in a representative sample of 5,240 households, we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practices., Results: Four of 14 newborn care practices were more commonly reported in intervention than comparison areas: delaying the baby's first bath by at least six hours (81% versus 68%, OR 2.0 (95% CI 1.2-3.4)), exclusive breastfeeding in the three days after birth (83% versus 71%, OR 1.9 (95% CI 1.3-2.9)), putting nothing on the cord (87% versus 70%, OR 2.8 (95% CI 1.7-4.6)), and, for home births, tying the cord with a clean thread (69% versus 39%, OR 3.4 (95% CI 1.5-7.5)). For other behaviours there was little evidence of differences in reported practices between intervention and comparison areas including childbirth in a health facility or with a skilled attendant, thermal care practices, breastfeeding within an hour of birth and, for home births, the birth attendant having clean hands, cutting the cord with a clean blade and birth preparedness activities., Conclusions: A home-based counselling strategy using volunteers and designed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania. Further research is needed to evaluate if, and at what cost, these gains will lead to improved newborn survival., Trial Registration: Trial Registration Number NCT01022788 (http://www.clinicaltrials.gov, 2009).
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- 2014
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36. Staff experiences of providing maternity services in rural southern Tanzania - a focus on equipment, drug and supply issues.
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Penfold S, Shamba D, Hanson C, Jaribu J, Manzi F, Marchant T, Tanner M, Ramsey K, Schellenberg D, and Schellenberg JA
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- Adult, Female, Focus Groups, Humans, Male, Middle Aged, Qualitative Research, Tanzania, Young Adult, Attitude of Health Personnel, Equipment and Supplies supply & distribution, Health Personnel psychology, Maintenance, Maternal Health Services organization & administration, Pharmaceutical Preparations supply & distribution, Rural Health Services
- Abstract
Background: The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse patient outcomes through delaying care provision. We aim to describe staff experiences of providing maternal and neonatal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies., Methods: Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items., Results: The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures with potential health risks to themselves as a result., Conclusions: Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions.
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- 2013
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37. Strategies for delivering insecticide-treated nets at scale for malaria control: a systematic review.
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Willey BA, Paintain LS, Mangham L, Car J, and Schellenberg JA
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- Animals, Global Health, Humans, Malaria economics, Plasmodium malariae, Plasmodium vivax, Public Health methods, Insecticide-Treated Bednets economics, Insecticides economics, Malaria prevention & control, Public Health economics, Social Marketing
- Abstract
Objective: To synthesize findings from recent studies of strategies to deliver insecticide-treated nets (ITNs) at scale in malaria-endemic areas., Methods: Databases were searched for studies published between January 2000 and December 2010 in which: subjects resided in areas with endemicity for Plasmodium falciparum and Plasmodium vivax malaria; ITN delivery at scale was evaluated; ITN ownership among households, receipt by pregnant women and/or use among children aged < 5 years was evaluated; and the study design was an individual or cluster-randomized controlled design, nonrandomized, quasi-experimental, before-and-after, interrupted time series or cross-sectional without temporal or geographical controls. Papers describing qualitative studies, case studies, process evaluations and cost-effectiveness studies linked to an eligible paper were also included. Study quality was assessed using the Cochrane risk of bias checklist and GRADE criteria. Important influences on scaling up were identified and assessed across delivery strategies., Findings: A total of 32 papers describing 20 African studies were reviewed. Many delivery strategies involved health sectors and retail outlets (partial subsidy), antenatal care clinics (full subsidy) and campaigns (full subsidy). Strategies achieving high ownership among households and use among children < 5 delivered ITNs free through campaigns. Costs were largely comparable across strategies; ITNs were the main cost. Cost-effectiveness estimates were most sensitive to the assumed net lifespan and leakage. Common barriers to delivery included cost, stock-outs and poor logistics. Common facilitators were staff training and supervision, cooperation across departments or ministries and stakeholder involvement., Conclusion: There is a broad taxonomy of strategies for delivering ITNs at scale.
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- 2012
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38. Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania.
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Gross K, Alba S, Glass TR, Schellenberg JA, and Obrist B
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- Abortion, Spontaneous psychology, Adolescent, Adult, Female, Humans, Middle Aged, Parity, Pregnancy, Regression Analysis, Socioeconomic Factors, Stillbirth psychology, Surveys and Questionnaires, Tanzania, Young Adult, Gestational Age, Health Knowledge, Attitudes, Practice ethnology, Patient Acceptance of Health Care psychology, Prenatal Care psychology
- Abstract
Background: Early and frequent antenatal care attendance during pregnancy is important to identify and mitigate risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. However, many pregnant women in sub-Saharan Africa start antenatal care attendance late, particularly adolescent pregnant women. Therefore they do not fully benefit from its preventive and curative services. This study assesses the timing of adult and adolescent pregnant women's first antenatal care visit and identifies factors influencing early and late attendance., Methods: The study was conducted in the Ulanga and Kilombero rural Demographic Surveillance area in south-eastern Tanzania in 2008. Qualitative exploratory studies informed the design of a structured questionnaire. A total of 440 women who attended antenatal care participated in exit interviews. Socio-demographic, social, perception- and service related factors were analysed for associations with timing of antenatal care initiation using regression analysis., Results: The majority of pregnant women initiated antenatal care attendance with an average of 5 gestational months. Belonging to the Sukuma ethnic group compared to other ethnic groups such as the Pogoro, Mhehe, Mgindo and others, perceived poor quality of care, late recognition of pregnancy and not being supported by the husband or partner were identified as factors associated with a later antenatal care enrolment (p < 0.05). Primiparity and previous experience of a miscarriage or stillbirth were associated with an earlier antenatal care attendance (p < 0.05). Adolescent pregnant women started antenatal care no later than adult pregnant women despite being more likely to be single., Conclusions: Factors including poor quality of care, lack of awareness about the health benefit of antenatal care, late recognition of pregnancy, and social and economic factors may influence timing of antenatal care. Community-based interventions are needed that involve men, and need to be combined with interventions that target improving the quality, content and outreach of antenatal care services to enhance early antenatal care enrolment among pregnant women.
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- 2012
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39. Human resources for health care delivery in Tanzania: a multifaceted problem.
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Manzi F, Schellenberg JA, Hutton G, Wyss K, Mbuya C, Shirima K, Mshinda H, Tanner M, and Schellenberg D
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Background: Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania., Method: A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task., Results: We found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey., Conclusion: This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.
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- 2012
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40. Neonatal deaths in rural southern Tanzania: care-seeking and causes of death.
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Mrisho M, Schellenberg D, Manzi F, Tanner M, Mshinda H, Shirima K, Msambichaka B, Abdulla S, and Schellenberg JA
- Abstract
Introduction. We report cause of death and care-seeking prior to death in neonates based on interviews with relatives using a Verbal Autopsy questionnaire. Materials and Methods. We identified neonatal deaths between 2004 and 2007 through a large household survey in 2007 in five rural districts of southern Tanzania. Results. Of the 300 reported deaths that were sampled, the Verbal Autopsy (VA) interview suggested that 11 were 28 days or older at death and 65 were stillbirths. Data was missing for 5 of the reported deaths. Of the remaining 219 confirmed neonatal deaths, the most common causes were prematurity (33%), birth asphyxia (22%) and infections (10%). Amongst the deaths, 41% (90/219) were on the first day and a further 20% (43/219) on day 2 and 3. The quantitative results matched the qualitative findings. The majority of births were at home and attended by unskilled assistants. Conclusion. Caregivers of neonates born in health facility were more likely to seek care for problems than caregivers of neonates born at home. Efforts to increase awareness of the importance of early care-seeking for a premature or sick neonate are likely to be important for improving neonatal health.
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- 2012
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41. Intermittent preventive treatment for malaria in infants: a decision-support tool for sub-Saharan Africa.
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Carneiro I, Smith L, Ross A, Roca-Feltrer A, Greenwood B, Schellenberg JA, Smith T, and Schellenberg D
- Subjects
- Africa South of the Sahara epidemiology, Age Distribution, Algorithms, Antimalarials administration & dosage, Child, Child, Preschool, Confidence Intervals, Epidemiologic Methods, Female, Hospitalization, Humans, Infant, Infant, Newborn, Malaria epidemiology, Malaria mortality, Male, Models, Theoretical, Stochastic Processes, Time Factors, Antimalarials therapeutic use, Decision Support Techniques, Health Policy, Malaria prevention & control, Plasmodium malariae isolation & purification
- Abstract
Objective: To develop a decision-support tool to help policy-makers in sub-Saharan Africa assess whether intermittent preventive treatment in infants (IPTi) would be effective for local malaria control., Methods: An algorithm for predicting the effect of IPTi was developed using two approaches. First, study data on the age patterns of clinical cases of Plasmodium falciparum malaria, hospital admissions for infection with malaria parasites and malaria-associated death for different levels of malaria transmission intensity and seasonality were used to estimate the percentage of cases of these outcomes that would occur in children aged <10 years targeted by IPTi. Second, a previously developed stochastic mathematical model of IPTi was used to predict the number of cases likely to be averted by implementing IPTi under different epidemiological conditions. The decision-support tool uses the data from these two approaches that are most relevant to the context specified by the user., Findings: Findings from the two approaches indicated that the percentage of cases targeted by IPTi increases with the severity of the malaria outcome and with transmission intensity. The decision-support tool, available on the Internet, provides estimates of the percentage of malaria-associated deaths, hospitalizations and clinical cases that will be targeted by IPTi in a specified context and of the number of these outcomes that could be averted., Conclusion: The effectiveness of IPTi varies with malaria transmission intensity and seasonality. Deciding where to implement IPTi must take into account the local epidemiology of malaria. The Internet-based decision-support tool described here predicts the likely effectiveness of IPTi under a wide range of epidemiological conditions.
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- 2010
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42. Age-patterns of malaria vary with severity, transmission intensity and seasonality in sub-Saharan Africa: a systematic review and pooled analysis.
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Carneiro I, Roca-Feltrer A, Griffin JT, Smith L, Tanner M, Schellenberg JA, Greenwood B, and Schellenberg D
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- Africa South of the Sahara epidemiology, Age Factors, Child, Child, Preschool, Humans, Infant, Patient Admission statistics & numerical data, Seasons, Malaria, Falciparum epidemiology, Malaria, Falciparum transmission
- Abstract
Background: There is evidence that the age-pattern of Plasmodium falciparum malaria varies with transmission intensity. A better understanding of how this varies with the severity of outcome and across a range of transmission settings could enable locally appropriate targeting of interventions to those most at risk. We have, therefore, undertaken a pooled analysis of existing data from multiple sites to enable a comprehensive overview of the age-patterns of malaria outcomes under different epidemiological conditions in sub-Saharan Africa., Methodology/principal Findings: A systematic review using PubMed and CAB Abstracts (1980-2005), contacts with experts and searching bibliographies identified epidemiological studies with data on the age distribution of children with P. falciparum clinical malaria, hospital admissions with malaria and malaria-diagnosed mortality. Studies were allocated to a 3x2 matrix of intensity and seasonality of malaria transmission. Maximum likelihood methods were used to fit five continuous probability distributions to the percentage of each outcome by age for each of the six transmission scenarios. The best-fitting distributions are presented graphically, together with the estimated median age for each outcome. Clinical malaria incidence was relatively evenly distributed across the first 10 years of life for all transmission scenarios. Hospital admissions with malaria were more concentrated in younger children, with this effect being even more pronounced for malaria-diagnosed deaths. For all outcomes, the burden of malaria shifted towards younger ages with increasing transmission intensity, although marked seasonality moderated this effect., Conclusions: The most severe consequences of P. falciparum malaria were concentrated in the youngest age groups across all settings. Despite recently observed declines in malaria transmission in several countries, which will shift the burden of malaria cases towards older children, it is still appropriate to target strategies for preventing malaria mortality and severe morbidity at very young children who will continue to bear the brunt of malaria deaths in sub-Saharan Africa.
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- 2010
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43. Household ownership and use of insecticide treated nets among target groups after implementation of a national voucher programme in the United Republic of Tanzania: plausibility study using three annual cross sectional household surveys.
- Author
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Hanson K, Marchant T, Nathan R, Mponda H, Jones C, Bruce J, Mshinda H, and Schellenberg JA
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- Adolescent, Adult, Bedding and Linens economics, Cross-Sectional Studies, Feasibility Studies, Female, Humans, Infant, Infant, Newborn, Malaria economics, Middle Aged, Mosquito Control economics, Motivation, Ownership, Patient Acceptance of Health Care, Pregnancy, Pregnancy Complications, Parasitic economics, Rural Health, Social Marketing, Socioeconomic Factors, Tanzania, Young Adult, Bedding and Linens supply & distribution, Insecticides, Malaria prevention & control, Mosquito Control methods, Pregnancy Complications, Parasitic prevention & control
- Abstract
Objectives: To evaluate the impact of the Tanzania National Voucher Scheme on the coverage and equitable distribution of insecticide treated nets, used to prevent malaria, to pregnant women and their infants., Design: Plausibility study using three nationally representative cross sectional household and health facility surveys, timed to take place early, mid-way, and at the end of the roll out of the national programme., Setting: The Tanzania National Voucher Scheme was implemented in antenatal services, and phased in on a district by district basis from October 2004 covering all of mainland Tanzania in May 2006., Participants: 6115, 6260, and 6198 households (in 2005, 2006, and 2007, respectively) in a representative sample of 21 districts (out of a total of 113)., Interventions: A voucher worth $2.45 ( pound1.47, euro1.74) to be used as part payment for the purchase of a net from a local shop was given to every pregnant woman attending antenatal services., Main Outcome Measures: Insecticide treated net coverage was measured as household ownership of at least one net and use of a net the night before the survey. Socioeconomic distribution of nets was examined using an asset based index., Results: Steady increases in net coverage indicators were observed over the three year study period. Between 2005 and 2007, household ownership of at least one net (untreated or insecticide treated) increased from 44% (2686/6115) to 65% (4006/6198; P<0.001), and ownership of at least one insecticide treated net doubled from 18% (1062/5961) to 36% (2229/6198) in the same period (P<0.001). Among infants under 1 year of age, use of any net increased from 33% (388/1180) to 56% (707/1272; P<0.001) and use of an insecticide treated net increased from 16% (188/1180) to 34% (436/1272; P<0.001). After adjusting for potential confounders, household ownership was positively associated with time since programme launch, although this association did not reach statistical significance (P=0.09). Each extra year of programme operation was associated with a 9 percentage point increase in household insecticide treated net ownership (95% confidence interval -1.6 to 20). In 2005, only 7% (78/1115) of nets in households with a child under 1 year of age had been purchased with a voucher; this value increased to 50% (608/1211) in 2007 (P<0.001). In 2007, infants under 1 year in the least poor quintile were more than three times more likely to have used an insecticide treated net than infants in the poorest quintile (54% v 16%; P<0.001)., Conclusions: The Tanzania National Voucher Scheme was associated with impressive increases in the coverage of insecticide treated nets over a two year period. Gaps in coverage remain, however, especially in the poorest groups. A voucher system that facilitates routine delivery of insecticide treated nets is a feasible option to "keep up" coverage.
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- 2009
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44. The acceptability of intermittent preventive treatment of malaria in infants (IPTi) delivered through the expanded programme of immunization in southern Tanzania.
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Pool R, Mushi A, Schellenberg JA, Mrisho M, Alonso P, Montgomery C, Tanner M, Mshinda H, and Schellenberg D
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- Female, Humans, Infant, Interviews as Topic, Malaria epidemiology, Tanzania epidemiology, Antimalarials administration & dosage, Malaria prevention & control, Malaria Vaccines administration & dosage, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Background: Intermittent preventive treatment of malaria in infants (IPTi) reduces the incidence of clinical malaria. However, before making decisions about implementation, it is essential to ensure that IPTi is acceptable, that it does not adversely affect attitudes to immunization or existing health seeking behaviour. This paper reports on the reception of IPTi during the first implementation study of IPTi in southern Tanzania., Methods: Data were collected through in-depth interviews, focus group discussions and participant observation carried out by a central team of social scientists and a network of key informants/interviewers who resided permanently in the study sites., Results: IPTi was generally acceptable. This was related to routinization of immunization and resonance with traditional practices. Promoting "health" was considered more important than preventing specific diseases. Many women thought that immunization was obligatory and that health staff might be unwilling to assist in the future if they were non-adherent. Weighing and socialising were important reasons for clinic attendance. Non-adherence was due largely to practical, social and structural factors, many of which could be overcome. Reasons for non-adherence were sometimes interlinked. Health staff and "road to child health" cards were the main source of information on the intervention, rather than the specially designed posters. Women did not generally discuss child health matters outside the clinic, and information about the intervention percolated slowly through the community. Although there were some rumours about sulphadoxine pyrimethamine (SP), it was generally acceptable as a drug for IPTi, although mothers did not like the way tablets were administered. There is no evidence that IPTi had a negative effect on attitudes or adherence to the expanded programme on immunisation (EPI) or treatment seeking or existing malaria prevention., Conclusion: In order to improve adherence to both EPI and IPTi local priorities should be taken into account. For example, local women are often more interested in weighing than in immunization, and they view vaccination and IPTi as vaguely "healthy" rather preventing specific diseases. There should be more emphasis on these factors and more critical consideration by policy makers of how much local knowledge and understanding is minimally necessary in order to make interventions successful.
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- 2008
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45. Understanding home-based neonatal care practice in rural southern Tanzania.
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Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, and Schellenberg D
- Subjects
- Breast Feeding ethnology, Culture, Female, Health Knowledge, Attitudes, Practice, Home Childbirth psychology, Humans, Infant Care standards, Infant Mortality trends, Infant, Newborn, Medicine, Traditional, Patient Acceptance of Health Care ethnology, Pregnancy, Qualitative Research, Rural Health standards, Socioeconomic Factors, Tanzania, Breast Feeding psychology, Home Care Services standards, Home Childbirth standards, Infant Care psychology, Mothers psychology, Patient Acceptance of Health Care psychology, Perinatal Care standards
- Abstract
In order to understand home-based neonatal care practices in rural Tanzania, with the aim of providing a basis for the development of strategies for improving neonatal survival, we conducted a qualitative study in southern Tanzania. In-depth interviews, focus group discussions and case studies were used through a network of female community-based informants in eight villages of Lindi Rural and Tandahimba districts. Data collection took place between March 2005 and April 2007. The results show that although women and families do make efforts to prepare for childbirth, most home births are assisted by unskilled attendants, which contributes to a lack of immediate appropriate care for both mother and baby. The umbilical cord is thought to make the baby vulnerable to witchcraft and great care is taken to shield both mother and baby from bad spirits until the cord stump falls off. Some neonates are denied colostrum, which is perceived as dirty. Behaviour-change communication efforts are needed to improve early newborn care practices.
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- 2008
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46. Vouchers for scaling up insecticide-treated nets in Tanzania: methods for monitoring and evaluation of a national health system intervention.
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Hanson K, Nathan R, Marchant T, Mponda H, Jones C, Bruce J, Stephen G, Mulligan J, Mshinda H, and Schellenberg JA
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- Animals, Female, Humans, Interdisciplinary Communication, Maternal-Child Health Centers statistics & numerical data, Mosquito Control methods, Pregnancy, Process Assessment, Health Care methods, Tanzania, Bedding and Linens economics, Insecticides economics, Malaria prevention & control, National Health Programs, Program Evaluation methods, Public Assistance
- Abstract
Background: The Tanzania National Voucher Scheme (TNVS) uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs) to pregnant women. The system began operation in October 2004 and by May 2006 was operating in all districts in the country. Evaluating complex public health interventions which operate at national level requires a multidisciplinary approach, novel methods, and collaboration with implementers to support the timely translation of findings into programme changes. This paper describes this novel approach to delivering ITNs and the design of the monitoring and evaluation (M&E)., Methods: A comprehensive and multidisciplinary M&E design was developed collaboratively between researchers and the National Malaria Control Programme. Five main domains of investigation were identified: (1) ITN coverage among target groups, (2) provision and use of reproductive and child health services, (3) "leakage" of vouchers, (4) the commercial ITN market, and (5) cost and cost-effectiveness of the scheme., Results: The evaluation plan combined quantitative (household and facility surveys, voucher tracking, retail census and cost analysis) and qualitative (focus groups and in-depth interviews) methods. This plan was defined in collaboration with implementing partners but undertaken independently. Findings were reported regularly to the national malaria control programme and partners, and used to modify the implementation strategy over time., Conclusion: The M&E of the TNVS is a potential model for generating information to guide national and international programmers about options for delivering priority interventions. It is independent, comprehensive, provides timely results, includes information on intermediate processes to allow implementation to be modified, measures leakage as well as coverage, and measures progress over time.
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- 2008
- Full Text
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47. Changing pattern of malaria in Bissau, Guinea Bissau.
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Rodrigues A, Schellenberg JA, Kofoed PE, Aaby P, and Greenwood B
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- Anemia, Iron-Deficiency epidemiology, Child, Preschool, Cross-Sectional Studies, Female, Guinea-Bissau epidemiology, Humans, Infant, Male, Malaria, Falciparum epidemiology, Parasitemia epidemiology
- Abstract
Objective: To describe the epidemiology of malaria in Guinea-Bissau, in view of the fact that more funds are available now for malaria control in the country., Methods: From May 2003 to May 2004, surveillance for malaria was conducted among children less than 5 years of age at three health centres covering the study area of the Bandim Health Project (BHP) and at the outpatient clinic of the national hospital in Bissau. Cross-sectional surveys were conducted in the community in different malaria seasons., Results: Malaria was overdiagnosed in both health centres and hospital. Sixty-four per cent of the children who presented at a health centre were clinically diagnosed with malaria, but only 13% of outpatient children who tested for malaria had malaria parasitaemia. Only 44% (963/2193) of children admitted to hospital with a diagnosis of malaria had parasitaemia. The proportion of positive cases increased with age. Among hospitalized children with malaria parasitaemia, those less than 2 years old were more likely to have moderate anaemia (RR = 1.27; 95% CI: 1.02-1.56) (P = 0.03) or severe anaemia (RR = 1.67; 95% CI: 1.25-2.24) (P = 0.0005) than older children. The prevalence of malaria parasitaemia in the community was low (3%, 53/1926)., Conclusion: In Bissau, the prevalence of malaria parasitaemia in the community is now low and malaria is over-diagnosed in health facilities. Laboratory support will be essential to avoid unnecessary use of the artemisinin combination therapy which is now being introduced as first-line treatment in Bissau with support from the Global Fund.
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- 2008
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48. Efficacy of pyrethroid-treated nets against malaria vectors and nuisance-biting mosquitoes in Tanzania in areas with long-term insecticide-treated net use.
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Kulkarni MA, Malima R, Mosha FW, Msangi S, Mrema E, Kabula B, Lawrence B, Kinung'hi S, Swilla J, Kisinza W, Rau ME, Miller JE, Schellenberg JA, Maxwell C, Rowland M, Magesa S, and Drakeley C
- Subjects
- Animals, Anopheles, Culex, Female, Humans, Insecticide Resistance, Malaria epidemiology, Malaria mortality, Male, Tanzania epidemiology, Treatment Outcome, Bedding and Linens, Insecticides, Malaria prevention & control, Mosquito Control methods, Pyrethrins
- Abstract
Objective: To measure pyrethroid susceptibility in populations of malaria vectors and nuisance-biting mosquitoes in Tanzania and to test the biological efficacy of current insecticide formulations used for net treatment., Methods: Anopheles gambiae Giles s.l., An. funestus Giles s.l. and Culex quinquefasciatus Say were collected during three national surveys and two insecticide-treated net (ITN) studies in Tanzania. Knockdown effect and mortality were measured in standard WHO susceptibility tests and ball-frame bio-efficacy tests. Test results from 1999 to 2004 were compared to determine trends in resistance development., Results: Anopheles gambiae s.l. and An. funestus s.l. were highly susceptible to permethrin (range 87-100%) and deltamethrin (consistently 100%) in WHO tests in 1999 and 2004, while Culex quinquefasciatus susceptibility to these pyrethroids was much lower (range 7-100% and 0-84% respectively). Efficacy of pyrethroid-treated nets was similarly high against An. gambiae s.l. and An. funestus s.l. (range 82-100%) while efficacy against Cx. quinquefasciatus was considerably lower (range 2-100%). There was no indication of development of resistance in populations of An. gambiae s.l. or An. funestus s.l. where ITNs have been extensively used; however, susceptibility of nuisance-biting Cx. quinquefasciatus mosquitoes declined in some areas between 1999 and 2004., Conclusion: The sustained pyrethroid susceptibility of malaria vectors in Tanzania is encouraging for successful malaria control with ITNs. Continued monitoring is essential to ensure early resistance detection, particularly in areas with heavy agricultural or public health use of insecticides where resistance is likely to develop. Widespread low susceptibility of nuisance-biting Culex mosquitoes to ITNs raises concern for user acceptance of nets.
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- 2007
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49. Factors affecting home delivery in rural Tanzania.
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Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, and Schellenberg D
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- Attitude of Health Personnel, Educational Status, Fees and Charges, Female, Health Knowledge, Attitudes, Practice, Home Childbirth economics, Humans, Labor, Obstetric psychology, Male, Patient Acceptance of Health Care psychology, Pregnancy, Quality of Health Care, Risk Factors, Rural Health, Socioeconomic Factors, Tanzania epidemiology, Transportation, Gender Identity, Home Childbirth psychology
- Abstract
Background: Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery., Methods: In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a cross-sectional survey of 21,600 randomly chosen households., Results: Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision-making power within the household were perceived as key determinants of the place of delivery. More than 9000 women were interviewed about their most recent delivery in the quantitative survey. There were substantial variations between ethnic groups with respect to place of delivery (P<0.0001). Women who lived in male-headed households were less likely to deliver in a health facility than women in female-headed households (RR 0.86, 95% CI 0.80-0.91). Mothers with primary and higher education were more likely to deliver at a health facility (RR 1.30, 95% CI 1.23-1.38). Younger mothers and the least poor women were also more likely to deliver in a health facility compared with the older and the poorest women, respectively., Conclusions: To address neonatal mortality, special attention should be paid to neonatal health in both maternal and child health programmes. The findings emphasize the need for a systematic approach to overcome health-system constraints, community based programmes and scale-up effective low-cost interventions which are already available.
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- 2007
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50. The use of personal digital assistants for data entry at the point of collection in a large household survey in southern Tanzania.
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Shirima K, Mukasa O, Schellenberg JA, Manzi F, John D, Mushi A, Mrisho M, Tanner M, Mshinda H, and Schellenberg D
- Abstract
Background: Survey data are traditionally collected using pen-and-paper, with double data entry, comparison of entries and reconciliation of discrepancies before data cleaning can commence. We used Personal Digital Assistants (PDAs) for data entry at the point of collection, to save time and enhance the quality of data in a survey of over 21,000 scattered rural households in southern Tanzania., Methods: Pendragon Forms 4.0 software was used to develop a modular questionnaire designed to record information on household residents, birth histories, child health and health-seeking behaviour. The questionnaire was loaded onto Palm m130 PDAs with 8 Mb RAM. One hundred and twenty interviewers, the vast majority with no more than four years of secondary education and very few with any prior computer experience, were trained to interview using the PDAs. The 13 survey teams, each with a supervisor, laptop and a four-wheel drive vehicle, were supported by two back-up vehicles during the two months of field activities. PDAs and laptop computers were charged using solar and in-car chargers. Logical checks were performed and skip patterns taken care of at the time of data entry. Data records could not be edited after leaving each household, to ensure the integrity of the data from each interview. Data were downloaded to the laptop computers and daily summary reports produced to evaluate the completeness of data collection. Data were backed up at three levels: (i) at the end of every module, data were backed up onto storage cards in the PDA; (ii) at the end of every day, data were downloaded to laptop computers; and (iii) a compact disc (CD) was made of each team's data each day.A small group of interviewees from the community, as well as supervisors and interviewers, were asked about their attitudes to the use of PDAs., Results: Following two weeks of training and piloting, data were collected from 21,600 households (83,346 individuals) over a seven-week period in July-August 2004. No PDA-related problems or data loss were encountered. Fieldwork ended on 26 August 2004, the full dataset was available on a CD within 24 hours and the results of initial analyses were presented to district authorities on 28 August. Data completeness was over 99%. The PDAs were well accepted by both interviewees and interviewers., Conclusion: The use of PDAs eliminated the usual time-consuming and error-prone process of data entry and validation. PDAs are a promising tool for field research in Africa.
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- 2007
- Full Text
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