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Objectives This study assesses associations between mistreatment by a provider during childbirth and maternal complications in Uttar Pradesh, India. Methods Cross-sectional survey data were collected from women (N = 2639) who had delivered at 68 public health facilities in Uttar Pradesh, participating in a quality of care study. Participants were recruited from April to July 2015 and surveyed on demographics, mistreatment during childbirth (measure developed for this study, Cronbach's alpha = 0.70), and maternal health complications. Regression models assessed associations between mistreatment during childbirth and maternal complications, at delivery and postpartum, adjusting for demographics and pregnancy complications. Results Participants were aged 17-48 years, and 30.3% were scheduled caste/scheduled tribe. One in five (20.9%) reported mistreatment by their provider during childbirth, including discrimination and abuse; complications during delivery (e.g., obstructed labor) and postpartum (e.g., excessive bleeding) were reported by 45.8 and 41.5% of women, respectively. Health providers at delivery included staff nurses (81.8%), midwives (14.0%), and physicians (2.2%); Chi square analyses indicate that women were significantly more likely to report mistreatment when their provider was a nurse rather than a physician or midwife. Women reporting mistreatment by a provider during childbirth had higher odds of complications at delivery (AOR = 1.32; 95% CI 1.05-1.67) and postpartum (AOR = 2.12; 95% CI 1.67-2.68). Conclusions for Practice Mistreatment of women by their provider during childbirth is a pervasive health and human rights violation, and is associated with increased risk for maternal health complications in Uttar Pradesh. Efforts to improve quality of maternal care should include greater training and monitoring of providers to ensure respectful treatment of patients., Author(s): Anita Raj [sup.1] , Arnab Dey [sup.2] , Sabrina Boyce [sup.1] , Aparna Seth [sup.2] , Siddhartha Bora [sup.2] , Dharmendra Chandurkar [sup.2] , Katherine Hay [sup.3] , Kultar [...]

Objective To evaluate the Impact on the quality of the care provided for childhood diarrhoea and pneumonia In Bihar, India, of a large-scale, social franchising and telemedicine programme-the World Health Partners' Sky Program. Methods We Investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers' performance between Implementation and non implementation areas were assessed using multivariate difference-in-difference linear regression models. Findings The programme did not significantly Improve health-care providers' knowledge or performance with regard to childhood diarrhea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. Conclusion Social franchising has received attention globally as a model for delivering high-quality care in rural areas In the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up. Objectif Evaluer l'impact d'un programme a large echelle de franchises sociales et de telemedecine--le programme <> de WHP (World Health Partners)--sur la qualite de la prise en charge de la diarrhee et de la pneumonie infantiles dans le Bihar, en Inde. Methodes Nous avons etudle les changements associes a ce programme en termes de connaissances et de performances des prestataires de soins de sante, en realisant 810 evaluations sur un echantillon representatif de prestataires de soins, dans des regions couvertes et non-couvertes par le programme. Les prestataires ont ete evalues en utilisant des scenarlos de patients hypothetiques et la methodedu patient standardise, avantetapres la mise en oeuvre du programme, en 2011 et 2014 respectivement. Les differences constatees dans les performances des prestataires entre les regions couvertes et non-couvertes par le programme ont ete evaluees avec des modeles multlvaries de regression lineaire de l'ecart des differences. Resultats Le programme n'a pas sensiblement ameliore les connaissances ou les performances des prestataires de soins en lien avec les deux maladies infantiles etudiees, dans le Bihar. En revanche, notre etude montre qu'un gros ecart persiste entre la connaissance des soins appropries et les soins effectlvement dispenses. Conclusion Les franchises sociales retiennent actuellement l'attention du monde entier en tant que solution envisageable pour obtenir des soins de grande qualite dans les regions rurales des pays en developpement, mais les donnees probantes sont encore rares. Nos resultats soulignent la necessite d'obtenir des donnees empiriques solides avant d'intenslfier le deploiement de programmes de franchises sociales. Objetivo Evaluar el impacto en la calidad de la atencion proporcionada para la diarrea y la neumonia infantiles en Bihar, India, de un programa de telemedicina y franquicia social a gran escala, el programa Sky de la ONG World Health Partners. Metodos Se investigaron los cambios relacionados con el programa en el conocimiento y el rendimiento de los proveedores de atencion de salud realizando 810 evaluaciones en una muestra representativa de proveedores en zonas en las que el programa se implemento y en zonas en las que no. Los proveedores fueron evaluados a traves de vinetas de pacientes hipoteticos y el metodo del paciente estandarizado antes y despues de la implementacion del programa, en 2011 y 2014, respectivamente. Se evaluaron las diferencias en cuanto al rendimiento de los proveedores entre las zonas de implementacion y las de no implementacion utilizando unos modelos de regresion lineal multivariates de diferencias en diferencias. Resultados El programa no mejoro de forma significativa el conocimiento ni el rendimiento de los proveedores de atencion de salud en cuanto a la diarrea o la neumonia infantil en Bihar. El resultado fue una gran y constante diferencia entre el conocimiento de la atencion adecuada y la que se proporcionaba. Conclusion La franquicia social ha recibido atencion a escala mundial como un modelo para proporcionar una atencion de alta calidad en zonas rurales del mundo en desarrollo, aunque los datos que lo fundamentan son escasos. Los resultados destacan la necesidad de una prueba empirica adecuada antes de ampliar los programas de franquicia social., Introduction Diarrhoea and pneumonia are leading causes of childhood morbidity and mortality despite being targeted by global investment in health for decades. In the last 5 years, these diseases were [...]