To see the other types of publications on this topic, follow the link: Child care services – Malawi.
Dissertations / Theses on the topic 'Child care services – Malawi'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Child care services – Malawi.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Alufandika, Dina. "Appraisal of community-based childcare practices in rural Malawi: the case of Malili traditional authority area, Lilongwe District." Thesis, University of Fort Hare, 2012. http://hdl.handle.net/10353/d1005968.
Full textAbstract:
The government of Malawi established the community based childcare (CBCC) programme with the aim of addressing early childhood problems and achieve national development in the long run. The CBCC programme, as one of the approaches to early childhood development (ECD), is guided by the national early childhood development policy. It promotes some practices that somehow deviate from the traditional childcare ways that communities have always known. Experience has shown that programmes that have elements of conflict with commonly held beliefs are bound to meet with resistance in society. The study employed a mini survey, focus group discussion, observation and document review to understand how the CBCC childcare practices in Malili intersect with commonly held beliefs about childcare as well as how they reflect on the national ECD policy. The study also focused on understanding the perceptions of community members on the CBCC programme. The study revealed that while some aspects of CBCC delivery conform to commonly held beliefs about childcare in the area under study, others diverge from such beliefs. Such convergence and divergence appear to be in line with the propositions of transformalist globalisation theory- one of the perspectives adopted for the study. The study also found that care practices at CBCC are not a true reflection of the national ECD policy as community members’ perceptions, poor community participation, poverty and lack of caregiver training in ECD contribute towards poor quality of care in CBCC, contrary to what is defined in the national ECD policy. The study also found that while both CBCC caregivers and sampled community members perceived the quality of care at the centers as poor, caregivers had a more positive perception towards the CBCC than community members. The study indicated that CBCC are centres of desperation for low economic status communities. Findings from the research have revealed that cultural values and commonly held beliefs, and exposure to new knowledge through globalisation play a role in determining childcare practices as well as perceptions towards them. In this sense the study has indicated that meanings that communities attach to development interventions influence their actions and perceptions towards it.
2
Källander, Karin. "Case management of childhood fevers in the community : exploring malaria and pneumonia care in Uganda /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-557-7/.
Full text
3
Nsimba, Stephen E. D. "Exploring malaria case management of underfive children in households and public primary health care facilities in the Kibaha district, Tanzania /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-614-6.
Full text
4
Linder, Laura A. Butterfield. "The ideology of care explaining the politics of child care in the United States, France, and Israel /." Click here for download, 2008. http://proquest.umi.com/pqdweb?did=1633770391&sid=1&Fmt=2&clientId=3260&RQT=309&VName=PQD.
Full text
5
McKee, Julie. "Corporate initiatives in providing child care services." Virtual Press, 1985. http://liblink.bsu.edu/uhtbin/catkey/421945.
Full textAbstract:
This thesis explores the initiatives possible for corporations interested in providing child care services to their employees. It also attempts to explain why corporations are becoming increasingly interested in providing this benefit to employees.A needs assessment survey was designed to discover the child care related needs of employees and to determine how child care responsibilities impact the work environment. An exploratory study was conducted of a sample of employees (N=127) at General Telephone in Fort Wayne, Indiana.Most employees, parents and non-parents, in this sample believed that child care responsibilities adversely affected productivity within their company. They also felt that company-sponsored child care assistance could improve productivity. Using the chi-square test of significance, child care responsibilities were significantly related to increased rates of absenteeism, work interruptions and turnover. There was substantial interest among employees in a corporate sponsored child care center and/or financial assistance to reduce the cost of child care expenses.
6
Dube, Queen. "Aetiology and outcome of neonatal sepsis and meningitis in Malawi." Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2005539/.
Full textAbstract:
In Malawi there has been significant progress in reducing post-neonatal and under-5 deaths over the past decade but very little progress in reducing neonatal deaths. The major causes of neonatal deaths in Malawi are prematurity, infections and birth asphyxia. Neonatal sepsis has been shown to have long term complications ranging from motor deficits to cognitive impairment, epilepsy and behavioural disorders in preterm very low birth weight infants in the developed setting. Contrary to the epidemiology in the developed setting where neonatal sepsis is predominantly seen in preterm low birth weight infants, in the developing setting neonatal sepsis is also common among term babies. However, very little is known on the long term outcome of neonatal sepsis in the resource restrained setting. In this thesis the aetiology and outcome of neonatal sepsis and meningitis is investigated. METHODOLOGY This was study had 2 components; a cross sectional arm and a prospective cohort arm. The cross sectional study was looking at the aetiology, resistance pattern and in hospital outcome of severe neonatal infection cases presenting at QECH in Blantyre. The prospective cohort arm involved participants who were recruited in the cross sectional arm at QECH and were residing within Blantyre urban and infants that never had an episode of severe neonatal infection were recruited from Zingwangwa health Centre. The infants from Zingwangwa acted as controls. The participants in the prospective cohort arm were followed up to the age of 1 year where neurodevelopmental outcomes were assessed using the Bayley’s assessment tool. These participants also had detailed neurologic examination during the follow up visits at 6 and 12 months of age. A comparison between the cases and controls was made to ascertain the impact of neonatal infection outcome. RESULTS During the study a total of 412 cases were enrolled in the cross sectional arm. 75% of the cases had late onset disease. GBS was the commonest organism grown in blood culture 17/42(40%) and CSF culture 16/33(48%). 44% had abnormal serum sodium levels on admission and hypernatraemia was independently associated with an increased risk of dying in hospital (8.34[95% CI 1.95-35.7]). 51% of the gram negative organisms were multidrug resistant. In the long term outcome neonatal sepsis without overt meningitis was associated with an up to 6.6 –fold {95% CI (2.38-18.4) increased risk of developmental delay at 1 year of age. Meningitis was associated with a 17-fold {95% CI 4.89- 61.7} increased risk of developmental delay at 1 year of age. Positive blood or CSF culture and being HIV exposed were independent predictors of delay at I year of age. CONCLUSION GBS is a significant cause of neonatal infections in Malawi. The magnitude of developmental delay observed in infants who had neonatal sepsis without meningitis is worrying up to 35% of these infants were delayed. It is therefore important to employ measures that can prevent neonatal infections. Follow up is recommended in infants who had an episode of severe neonatal infection.
7
Chilma, Dorothy Madalo. "Nutritional status and functional ability of older people in rural Malawi." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312510.
Full text
8
Coonce, Donna J. "Empowering parents in their child care decisions /." View online, 1997. http://repository.eiu.edu/theses/docs/32211998827285.pdf.
Full text
9
Al-Ali, Ibrahim Jassim. "Child care policy and fostering in Kuwait." Thesis, Cardiff University, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.238135.
Full text
10
Ritter, Regina [Verfasser]. "Access and Barriers to Health Care Services in rural Malawi / Regina Ritter." Bonn : Universitäts- und Landesbibliothek Bonn, 2021. http://d-nb.info/1230878580/34.
Full text
11
Bula, Agatha Kapatuka. "Influences of HIV on exclusive breastfeeding : an exploration of community-based peer support in rural Malawi." Thesis, City University London, 2015. http://openaccess.city.ac.uk/14679/.
Full textAbstract:
Exclusive breastfeeding (EBF) for 6 months is recommended as the most cost-effective public health intervention to improve child survival particularly in Sub-Saharan Africa and is central to achieving Millennium Development Goal number 4 for child health. However, despite the benefits of EBF to infants and mothers, the rates continue to decrease as the age of the infant increases in an African cultural context including Malawi. There is increasing literature on the effectiveness of community-based peer counselling on EBF promotion in resource-poor settings but its effectiveness in the context of HIV and experiences of HIV positive women with the intervention remains a gap. The purpose of this thesis was to explore determinants of EBF using MaiMwana infant feeding peer-counselling intervention conducted in Mchinji, Malawi as a case study. Specifically, in this study I explored the effectiveness of the intervention to help HIV positive women to overcome the barriers and examine people’s experiences and perceptions towards the intervention with respect to HIV and poverty. I adopted qualitative in-depth interviews with 39 informants, including breastfeeding mothers, peer counsellors and key informants who were purposely selected. The data was analysed using a framework approach. I found that despite having good knowledge, women from rural communities face considerable challenges while practicing EBF. Cultural beliefs, economic constraints, lack of power and support, and fear of transmitting the virus to their infants were cited as major barriers that prevented them from practicing EBF. Overall, the findings from this study suggest that peer counsellors are well accepted by service-users and other community members as they positively viewed their frequent visits as providing additional support, reinforcing infant feeding messages and provide psychological support to women resulting in improved EBF rates. Furthermore, the presence of peer counsellors was viewed as “bringing services at their door step” which reduced time and cost to travel to the health facility. Nevertheless, the findings suggest that voluntary work in resource-poor settings presents considerable challenges such as: poor motivation due to lack of incentives, overworking, lack of knowledge and time to handle HIV positive cases and poor supervision. In order to effectively promote EBF in resource-poor settings, public health programme designers and implementers need to consider these barriers so as to design community-based interventions that suit the local context and create an enabling environment.
12
Uta, Joseph J. "Health communication to rural populations in developing countries : with special reference to Malawi." Thesis, Loughborough University, 1993. https://dspace.lboro.ac.uk/2134/13774.
Full textAbstract:
The findings of KAP studies and health reports indicate that in spite of continuing efforts by developing countries like Malawi, to raise health awareness among their peoples, the majority of the people remain inadequately informed and are generally found to lack basic knowledge about most prevalent diseases. As a result most people are unable to participate fully in primary health care activities. Two parallel surveys were carried out: (i) on activities of providers of information; and (ii) on information-seeking behaviour of a sample of the public. A health knowledge test was conducted to a sample of the public in order to assess their levels of Aids and bilharzia awareness. On matching the findings from the two surveys the following deficiencies were identified. The major cause of problems was that information provision was fragmented. Conflicting messages were given by different agencies which appeared to compete with each other. Distribution and access to the available information was also found to cause problems. Lack of research-based knowledge among health information providers about information needs and information-seeking behaviour of the people they are planning services for compounds the problems of information provision. Potential solutions include coordinating all activities of health communication from top-to-bottom (i.e. from planning to implementation at the community level). Efforts towards strengthening extension services, consolidating and repackaging of information, and consolidating of health grey literature are argued to be appropriate. Promoting use and marketing of the available information among the rural populations is also argued to be appropriate.
13
Kainja, Esmie Tamanda Vilili. "A study of child-related policies, services and the needs of orphans in Malawi." Thesis, University of Leeds, 2012. http://etheses.whiterose.ac.uk/5049/.
Full textAbstract:
Introduction: Due to HIV/AIDS epidemic, Malawi experienced a proliferation of orphans. These orphans are experiencing difficulties in meeting the basic necessities of daily life. Hence, donors have increased funding, Government has developed new policies for children and orphans and many civil society organisations are providing services to orphans. However, there is a paucity of research to establish the responsiveness of these initiatives to the needs of orphans. Purpose: The aim of this thesis was to assess how child-related policies and service delivery were responding to the needs of orphans. The research was designed to identify weaknesses and strengths in service delivery and policy design with the intention of proposing strategies and making recommendations to better address the needs of orphans. Methods: In 2010, 72 in-depth interviews were conducted in Blantyre and Lilongwe districts in Malawi. These comprised of 16 orphans aged 13-16 years, 12 caregivers, 12 national service providers and 13 policy makers. In addition, 12 interviews were conducted with participants playing both policy and service provision roles. Seven focus group discussions were conducted with district and community service providers. Government policies were also reviewed. Data were analysed using framework analysis. Findings: Food was found to be the most critical need among orphans, followed by financial security for meeting needs autonomously. Child-related polices did not fully guide service implementation due to weak policy coordination, lack of alignment between structures stipulated in policy and structures used in for policy implementation, poor policy design and limited participation of service users and stakeholders in policy development and implementation. Non-comprehensive services, poor service integration, inequitable service delivery, inaccessible services and insufficient resources were found to undermine service responsiveness to orphans’ needs. Recommendations: To improve orphan related policies and service delivery, policies and services should focus on improving service coordination, resource mobilisation and policy design. Donors and non-governmental organisations should operate within Government plans, priorities and implementation structures. Services should prioritise food and household income generation strategies.
14
Munthali, Spy Mbiriyawaka. "An institutional analysis of community and home based care and support for HIV/AIDS sufferers in rural households in Malawi." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1002719.
Full textAbstract:
Standard economic models often emphasize inputs, outputs and an examination of the structures in order to conduct an economic performance evaluation. This study applies the Institutional and Development Framework (IAD) in the broader context of New Institutional Economics (NIE) in order to examine the transaction costs of delivering Community and Home Based Care and Support (CHBC) to HIV/AIDS sufferers. For purposes of unveiling the empirical reality guiding decision making processes in the CHBC service delivery, comparative qualitative research techniques of normative variable and concept formation have been adopted to draw out the relative institutional influences from the HIV/AIDS national response partnerships. The study identifies the conflict between the predominantly standardized and more rigid formal management techniques adopted by key members of the national response and the informal cultural techniques familiar to the rural communities, and a lack of motivational incentives in the CHBC structures as the key factors against CHBC capacities to draw external funding for service delivery. CHBCs are also weakened by incoherent governance structures at the district level for facilitation of funding and information flow exacerbating the community vulnerability. Rationalization of the institutional arrangements and a clarification of roles from district to community levels, a shift of focus to facilitation of informal techniques and an integration of performance enhancing incentives are the critical policy insights envisaged to spur CHBCs to work better.
15
Ma, Kwong-cho. "Unattended child : an area of neglect in Hong Kong /." Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22054467.
Full text
16
Newell, Amy Noël Abell Ellen Elizabeth. "Quality in family child care the voice of the family child care provider /." Auburn, Ala, 2009. http://hdl.handle.net/10415/1632.
Full text
17
Waters, Elizabeth. "Measuring child health and wellbeing." Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270153.
Full text
18
Manthalu, Gerald Herbert. "The impact of user fee exemption on maternal health care utilisation and health outcomes at mission health care facilities in Malawi." Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=214843.
Full textAbstract:
The Government of Malawi has entered into agreements with Christian health association of Malawi (CHAM) health care facilities in order to exempt their catchment populations from paying user fees. These agreements are called service level agreements (SLAs). Government in turn reimburses the CHAM health care facilities for the health services that they provide. The agreements started in 2006 with 28 out of 166 CHAM health care facilities and increased to 68 in 2010. The aim of the exemption policy is to guarantee universal access to a basic package of health care services. Although the agreements were designed to cover every health service in the basic health care package, only maternal and neonatal health services are included due to limited resources. The main objective of this thesis was to evaluate the impact of the health care financing change on health care utilisation and health. The specific objectives were as follows: first, to examine whether health care facility visits for maternal health care changed due to user fee exemption; second, to evaluate whether user fee exemption affected the choice of the health care provider where women living in the catchment areas of CHAM health care facilities with user fee exemption sought maternal health care; third, to analyse the effect of user fee exemption on birth weight and; fourth, to explore and apply novel methods in the evaluation of user fee exemption. The gradual uptake of service level agreements by CHAM health care facilities provided a natural experiment with treated and control health care facilities. An additional control group comprised of other demographic groups apart from pregnant women and neonates at CHAM health care facilities with service level agreements. In household survey data, individuals were assigned to treatment and control groups based on their proximity to either a CHAM health care facility with SLA or a CHAM health care facility without SLA. This proffered the unique opportunity to estimate the effect of a single treatment on multiple outcomes. The difference-in-differences (DiD) approach was used to obtain causal effects of user fee exemption. It was implemented in the context of fixed effects, switching regression and multinomial logit models across different chapters. Health care facility level panel data for utmost 146 health care facilities for a maximum of 8 years, 2003-2010, were used. The data were obtained from the Malawi health management xiii information system (HMIS). Linked survey data were also used. Malawi demographic and survey data for 2004 and 2010 were linked to health care facility data and then merged. Analyses that utilised health care facility data showed that user fee exemption had led to increases in first antenatal care visits in the first trimester, first antenatal care visits in any trimester, average antenatal care visits and deliveries at CHAM health care facilities with SLAs. Results from survey data showed that the probability of using a CHAM health care facility with user fee exemption for antenatal care increased, the probability of using home antenatal care declined and the probability of not using antenatal care also declined due to user fee exemption. The probability of delivering at a CHAM health care facility with SLA also increased while the probability of delivering at home declined. User fee exemption did not affect the choice of where to go for postpartum care. Results of the effect of user fee exemption on birth weight were not reported because of potential endogeneity bias arising from lack of instrumental variables for antenatal care. The key policy messages from this thesis are that the user fee exemption policy is an important intervention for increasing the utilisation of maternal health care and needs to be extended to as many CHAM health care facilities as necessary. User fee exemption is not enough, however. Other factors such as education of the woman and her husband/partner, wealth status and cultural factors are also important. This thesis has contributed to the body of knowledge in the following ways. First, it has generated evidence on the impact of user fee exemption on maternal health care utilisation and birth weight in Malawi. Second, with respect to maternal health care utilisation, the thesis has looked at variables that capture the whole maternal health care process from early pregnancy to postpartum care and in a policy relevant way. Third, the thesis has evaluated the effect of user fee exemption on a variable that have not been looked at before, first antenatal care visits in the first trimester. Fourth, the thesis has examined the effect of a single treatment on multiple outcomes in a methodologically unique way. Treatment effects, which were the changes in the probabilities of using different alternatives summed up to zero, thus showing where any increase in the probability of using the outcome of interest came from. Fifth, this thesis is first to use disequilibrium theory of demand and supply in health economics. Application of this theory entailed using switching regression models with unknown sample separation, a seldom used estimation method in health economics. This was an important contribution to the methods xiv of analysing aggregate health care utilisation. Sixth, the STATA program that was written for the estimation of the disequilibrium models was itself a very important contribution to the methods for estimating aggregate supply and demand.
19
Dahlström, Margareta. "Service production uneven development and local solutions in Swedish child care /." Uppsala : Distribution, Kulturgeografiska institutionen, Uppsala universitet, 1993. http://catalog.hathitrust.org/api/volumes/oclc/30694948.html.
Full text
20
Stewart, Latonia A. "An exploration of characteristics, child development knowledge, sources of information, and training needs of family home providers /." View online, 1993. http://repository.eiu.edu/theses/docs/32211131396959.pdf.
Full text
21
Jones, Cathy R. "Developing a West Virginia child care director's credential identifying the knowledge, skills, and issues /." Morgantown, W. Va. : [West Virginia University Libraries], 2000. http://etd.wvu.edu/templates/showETD.cfm?recnum=1399.
Full textAbstract:
Thesis (Ed. D.)--West Virginia University, 2000.Title from document title page. Document formatted into pages; contains ix, 165 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 143-149).
22
Mkandawire, Leona Temwa. "The balance between child autonomy and parental autonomy in Malawi; an analysis of the Child Care, Protection and Justice Act." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27993.
Full textAbstract:
For a long time children have been considered to be vulnerable persons, incapable of making rational decisions. As a result, decisions have been made for children by other people such as their parents or guardians. In most African societies, including Malawi, children remain largely voiceless and dependent on their parents who view their role mainly as being to protect children from their own actions and actions of other people. However, international law considers children as autonomous persons capable of making their own decisions. Thus, it requires states to recognise the autonomy a child although it also recognises that parents are free to raise children the way they want. Both the CRC and the African Children's Charter recognise children as bearers of rights and guarantee their right to take part in decisions that affect them. These treaties also recognise the principles of the best interests of the child, non-discrimination, and the child's right to life, survival and development. This thesis finds that while the best interests' principle has been domesticated under the Constitution, the other principles are not explicitly entrenched in the Constitution or under the Child Care, Protection and Justice Act. At best, they can be implied in other provisions of the Act. Overall, the Child Care, Protection and Justice Act leans towards enhancing the parental autonomy in child rearing and institutional protection of children rather than towards the emancipation of children in accordance with their evolving capacities.
23
Vaughan-Thomas, Non. "The child, first and always? Aspects of children's health care interests." Thesis, University of Cambridge, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.240053.
Full text
24
Smith, Jennifer Ann. "An explorative study of child and youth care workers experiences of "lifespace therapeutic care"." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=init_4931_1178701317.
Full textAbstract:
The goal of this research was to explore and describe child and youth care workers lived experiences of life space therapeutic care in a residential setting. Life space refers to the daily living environment, context and situation of children.
25
Brookes, Sheila J. "An examination of child care subsidies and their impact on families with infants and toddlers /." free to MU campus, to others for purchase, 2002. http://wwwlib.umi.com/cr/mo/fullcit?p3074380.
Full text
26
Kachimanga, Chiyembekezo. "Improving utilization of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29240.
Full textAbstract:
Introduction: Malawi has one of the highest maternal mortality ratio (MMR) in sub-Saharan Africa (SSA). Despite investments in family planning and emergency obstetric care (EmOC), Malawi’s Millennium Development Goal (MDG) target of reducing maternal deaths to 155 deaths per 100,000 live births was not met by the end of 2015. Between 2010 and 2015, Malawi was only able to reduce the MMR from 675 to 439 per 100,000 live births. Inadequate utilisation of perinatal services is the contributing factor to the MMR target not being achieved. One approach for improving the utilisation of perinatal services is to invest in community health workers (CHWs). CHWs can be trained to: identify women of child bearing age (WCBA) who need perinatal services; provide community education; encourage timely referral of clients to the nearest health facility; and undertake community follow up for WCBA who are pregnant and/or have recently given birth. We evaluated changes in utilisation of antenatal care (ANC), facility based births, and postnatal care (PNC) after CHW deployment to conduct monthly home visits to WCBA for pregnancy identification and escorting women to ANC, labour and facility birth and PNC clinics in Neno district, Malawi. The CHW programme was implemented in two catchment areas from March 2015 to June 2016.
Methodology: We employed a retrospective quasi-experimental study design to evaluate the impact of CHWs on changes in the utilisation of ANC, facility based births, and PNC in Neno district, Malawi between March 2014 and June 2016 (pre-intervention period: March 2014 to February 2015, and post- intervention period: March 2015 to June 2016). Monthly outcomes were compared between a combined CHW intervention area and its synthetic control area using the synthetic control method. The synthetic control area (or synthetic counterfactual of the CHW) was the control area that was created from multiple available control sites where the CHW programme was not implemented to allow the comparison of outcomes between the sites where CHWs were implemented and the sites where CHWs was not implemented. Two hundred and eleven CHWs (128 existing CHWs plus 83 new CHWs from the community) were trained in maternal health and deployed to cover an estimated 5,132 WCBA living in a catchment area of about 20,530 people. The primary focus of the CHWs was to conduct monthly household visits to identify pregnant women, and then escort pregnant women to their initial and subsequent ANC appointments, facility births, and to PNC check-ups. As part of package of care, community mobilisation and improvements in services to achieve a minimum package of services at the local health centres were also added. Using the synthetic control method, as developed by Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) and a Bayesian approach of synthetic control developed by Brodersen (2015), a synthetic counterfactual of the CHW intervention was created based on six available public control facilities. The synthetic counterfactual trend was created to have similar preintervention characteristics as the CHW intervention trend. The impact of the CHW intervention was the difference between the CHW intervention site and its synthetic counterfactual
Results: CHWs in the intervention areas visited an average of 3,147 (range 3,036 – 3,218) of WCBA monthly, covering 61.0% of WCBA. During these visit 3.6% (97 women per month) of WCBA were suspected to be pregnant every month. Of those women suspected to be pregnant, 67.8% (66 women per month) were escorted to health facilities immediately every month. CHWs visited an average of 254 pregnant women enrolled in ANC and 64 women in postpartum period monthly. ANC and facility births utilisation in the CHW intervention site increased in comparison to the control site. Firstly, the number of new pregnant women enrolled in ANC per month increased by 18.0 % (95% Credible Interval (CrI) 8.0%, 28.0%), from 83 to 98 per pregnant women. Secondly, the proportion of women starting ANC in first trimester increased by 200.0% (95% CrI 162.0%, 234.0%), from 9.5% to 29.0% per month. Thirdly, the number of women attending four or more ANC visits increased by 37.0% (95% CrI 31.0%, 43.0%), from to 28.0% to 39.0%. Lastly, the number of facility births increases by 20% (CrI 13.0%, 28.0%), from 85 women to 102 per month. However, there was no net difference on PNC visits between the CHW intervention site and its counterfactual unit (-37.0%, 95% CrI -224.0%, 170.0%).
Conclusions: CHW intervention significantly increased the utilisation of ANC and facility based births in Neno, Malawi. However, CHWs had no net difference on PNC utilisation.
27
NEVES, TICIANA MASCARENHAS GALEAO. "MAIN MARKET DETERMINANTS OF CHILD CARE SERVICES IN RIO DE JANEIRO." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2009. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=14175@1.
Full textAbstract:
A primeira infância é fundamental para o desenvolvimento físico e
psíquico dos seres humanos, influenciando-os pelo resto da vida. Assim sendo,
a oferta de serviços de creche adequados, calcados no correto mapeamento dos
desejos e necessidades dos consumidores, é de extrema importância. Partindo
desta motivação, este trabalho objetiva analisar as características relevantes
para os pais no processo de seleção de creches. A dissertação é baseada na
metodologia da análise conjunta e seu desenvolvimento é composto de duas
etapas: i. Revisão da literatura, entrevistas em profundidade, grupo de foco e
definição dos estímulos a serem avaliados pelos respondentes; ii. Coleta de
dados, cálculo das importâncias relativas dos atributos, cálculo das utilidades
dos níveis propostos e análise dos resultados. A análise dos resultados é feita
considerando-se não somente o total da amostra como também segmentos
definidos a priori de acordo com dados sócio-econômicos levantados na coleta
de dados. O resultado da análise conjunta para o total da amostra revela os
atributos localização, projeto pedagógico e grau de capacitação dos
profissionais como sendo os de maior importância relativa. Este resultado
evidencia que, muito além da praticidade de creches que sejam guardiãs de
seus filhos, os pais buscam também uma instituição que propicie o
aprendizado e a socialização. Na segmentação, os resultados por região de
residência, faixa etária das crianças e faixa de renda familiar possibilitaram a
definição de estratégias específicas para cada segmento.The first childhood is fundamental for the physical and psychological development of human beings, influencing them for the rest of their lives. In this way, offering adequate child care services, based in a correct mapping of customers’ necessities is extremely important. Derived from this motivation, this work aims to analyze the relevant characteristics for parents in the child care services selection process. The dissertation is based on conjoint analysis methodology and is developed in two parts: i. Literature revision, interviews, focus groups and definition of the stimulus to be evaluated by the respondents; ii. Data collection, calculation of the relative importance of the attributes, calculation of the utilities of each suggested level and analyses of the results. The analysis is done considering not only the total sample but also segments defined according to socio-economical data gathered as part of the data collection process. The result of the conjoint analysis for the overall sample reveals that location, teaching methodology and professional knowledge and skills received the greatest relative importance. It shows that, far beyond a practical child care service that can look after their children, parents are aiming for an institution that leverages development, socialization and learning. When segmenting the data, analyses by neighborhood, children’s age and familiar income enabled the definition of strategies for each specific segment.
28
Kansteiner, Suzanne. "A parent handbook for family childcare programs." [Denver, Colo.] : Regis University, 2007. http://165.236.235.140/lib/SKansteiner2007.pdf.
Full text
29
Kasenga, Fyson. "Making it happen prevention of mother to child transmission of HIV in rural Malawi /." Doctoral thesis, Umeå : Umeå university, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-26223.
Full text
30
Li, Jun. "The use of child health computing systems in primary preventive care : an evaluation." Thesis, University College London (University of London), 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274686.
Full text
31
Nupponen, Hannele. "Leadership and Management in Child Care Services: Contextual Factors and Their Impact on Practice." Queensland University of Technology, 2005. http://eprints.qut.edu.au/16094/.
Full textAbstract:
There has been minimal Australian research focussed on the management and leadership aspects of directors' work in centre-based child care to date. In Australia, practices in early education have been largely drawn from studies in other cultural contexts, particularly research undertaken in the United States. It is timely that Australian research should inform its social policy about quality child care programs. The focus of this research was on the nature and characteristics of effective management and leadership practices in centre-based child care. Research (Jorde Bloom, 1992b; Morgan, 2000; Poster & Neugebauer, 2000; Rodd, 1994) indicates that quality of child care programs is influenced mostly by the leadership that the centre director can provide to staff within the centre. The conceptual framework adopted in this study views leadership from a Social Systems framework. Central to a Social Systems framework is the notion that organisations do not exist in isolation rather, leadership and management in these settings are embedded in a broader social context. A Social Systems Model has received little attention in contemporary research on child care in Australia, and this study aims to build a framework for future studies in this area. The aim was to investigate leadership and management in child care in social, legislative and economic context. The findings seek to inform researchers, policy makers and practitioners. Eight directors were purposively selected from community-based and privately based centres in urban and rural areas, and from accredited centres in South East Queensland. The selection of varying locations allowed the researcher to gain a broader perspective of the directors' daily lives, as different contextual and environmental conditions were anticipated to influence management and leadership within the child care centres. Within this study, case studies of directors of child care centres were developed through interviews with the directors. The interview methodology focussed on exploratory semi-structured, open-ended questions in relation to management and leadership in centre-based child care. Directors were interviewed on two occasions within a three month period. In the current context of the delivery of child care services in a market driven climate, the language of business and organisational theory has entered the lexicon of the early childhood field (Press, 1999). The findings indicate that the director of a child care centre needs to have training and experience in business management and leadership to enhance their competencies for management of centres in today's competitive environment. Growth in child care franchises is significantly changing and truly developing a "child care industry" (Murdoch, 2004). Also, consideration needs to be given to increasing accountability in child care service delivery, and how to better support directors in their role as advocates in the broader early childhood field. Further, families in specific communities have varying needs and early childhood programs should reflect the needs of the local community. Leadership models within child care centres should encompass the micro and macro influences on the operation of centres. Literature suggests that early childhood centres provide an opportune place to support families in a variety of ways through integrating support services to address the underlying social and policy factors that affect young children and their families (Commonwealth of Australia, 2003; Corter, 2001).
32
Anderson-Michael, Julie L. "A study of the first four fiscal years of Eastern Illinois University School of Family & Consumer Sciences Child Care Resource & Referral /." View online, 1996. http://repository.eiu.edu/theses/docs/32211998764272.pdf.
Full text
33
Park, Sun-Young. "Child Care Services: Two Statistical/Econometric Approaches to Household Choice and Demand /." The Ohio State University, 1995. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487931512617121.
Full text
34
Inkelas, Moira. "Incentives in a specialty care carve-out." Santa Monica, CA : RAND Graduate School, 2001. http://catalog.hathitrust.org/api/volumes/oclc/47357973.html.
Full text
35
Vasey, Jackie. "Tokenism or true partnership : parental involvement in a child's acute pain care." Thesis, University of Huddersfield, 2015. http://eprints.hud.ac.uk/id/eprint/26181/.
Full textAbstract:
Background: Despite the growing evidence about acute pain management in children and the availability of practice guidelines, children still experience unnecessary pain when in hospital. Involving parents in their child’s pain care has been identified as being central to the pain management in children. However, little is known about how parents and nurses work in partnership in acute children’s wards to care for the child experiencing pain. This thesis explored the experiences and perceptions of parents and nurses and the extent to which parents are involved and partners in the child’s pain care, and the factors that influence parental involvement in care. The family-centred care practice continuum was the theoretical framework that underpinned the study. Methods: A qualitative ethnographical study using non-participant observation and follow up interviews was undertaken. Fourteen nurses and 44 parents/grandparents participated, recruited from the children’s wards of two district general hospitals. The framework approach underpinned data analysis. Findings: While some evidence of parental involvement was identified, the study revealed variations in the way parents are involved in their child’s pain care. A range of challenges were highlighted in relation to the implementation of family-centred care as an approach to promote parental involvement in care. Parents wanted to be more involved in their child’s pain care, and act as an advocate for their child, particularly when they perceived their child’s pain care to be sub-optimal. At times nurses created barriers to parental involvement in pain care, for example, by not communicating effectively with parents and planning pain care without involving parents. The ‘Pillars of Partnership in Pain Care Model’ is offered as an alternative approach to engaging with parents, to address the barriers to involvement and assist nurses shift from a paternalistic approach to involvement to one of working collaboratively with parents in the context of the care of child in pain. Conclusions and implications for practice: Parental involvement in their child’s acute pain care can improve the child’s pain experience, increase parents’ satisfaction in care and reduce parental anxiety. The challenge for nurses is to embrace parental contribution to care and develop the confidence to support parents to advocate for their child.
36
Elliott, Roslyn, University of Western Sydney, of Arts Education and Social Sciences College, and School of Education and Early Childhood Studies. "The book is open but you can't turn the page: parents' perceptions of early childhood service quality." THESIS_CAESS_EEC_Elliot_R.xml, 2003. http://handle.uws.edu.au:8081/1959.7/800.
Full textAbstract:
This research examines parents’ perceptions of quality on early childhood services as they support families in the care and education of children. Data were collected from parents of under school-aged children using interviews, questionnaires and focus groups. Data analysis has enabled a determination of: the link between parents’ perceptions of quality and early childhood professionals’ views as expressed in the literature; parents’ satisfaction with services and the evaluation processes used by them; opportunities available to parents to engage with service staff to influence the quality of the services provided; and parents’ knowledge and use of the information services provided by the National Childcare Accreditation Council to assist them in their decision making regarding early childhood services. Results showed that communication between parents and staff is problematic. An accretion model of communication is developed to enhance the quality of early childhood services by promoting shared understanding and values between parents and staff, enabling parents to take part in decision making and minimising perceptions of threat to staff’s professional integrityUniversity of Western Sydney
37
Heath, Gemma Louise. "The experience of paediatric care closer to home : a place and space perspective." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4724/.
Full textAbstract:
NHS reforms have sought to ensure that children and young people who are ill receive timely, high quality and effective care as close to home as possible (DH, 2004). This study examined the experience and impact of introducing new, ‘closer to home’ community-based paediatric outpatient clinics from the perspectives of NHS service-users and providers. Twenty-seven interviews conducted with parents and patients (aged 8-16), were analysed using a descriptive phenomenological approach. Thirty-seven interviews conducted with healthcare professionals, were analysed using a thematic framework method. Findings reveal that paediatric outpatient ‘care close to home’ is experienced in ways that go beyond concerns about location and proximity. For families it means care that ‘fits into their lives’ spatially, temporally and emotionally; facilitating a sense of ‘at-homeness’ within the self and within the place, through the creation of a warm and welcoming environment, and by providing timely consultations which attend to aspects of the families’ lifeworld. For service-providers, place and professional identity were closely related, with implicit assumptions made about where high quality of care and clinical expertise were located. Place, time and human relations were thus shown to be meaningful constituents of the experience of paediatric outpatient care. These previously ‘taken-for-granted’ nuances of healthcare delivery have implications for the design and implementation of effective ‘closer to home’ services.
38
Gharaibeh, Muntaha Khaleel. "Maternal knowledge, beliefs, attitudes and practices relating to child immunization among Jordanian mothers." Thesis, University of Ulster, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390060.
Full text
39
Ellis, Kimberly R. "Foster parents' perceptions of independent living services for youth who age out of the system." Menomonie, WI : University of Wisconsin--Stout, 2004. http://www.uwstout.edu/lib/thesis/2004/2004ellisk.pdf.
Full text
40
Terling, Toni Lynn. "Family reunification practices of child protective services : interventions and outcomes /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.
Full text
41
Galli, Megan M. "The effects of child care quality on preschoolers' sleep patterns." abstract and full text PDF (free order & download UNR users only), 2007. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1442875.
Full text
42
Lofink, Diane L. H. "The effect of providing on-site child care services on personnel productivity, morale, and retention." Thesis, Monterey, California : Naval Postgraduate School, 1990. http://handle.dtic.mil/100.2/ADA237494.
Full textAbstract:
Thesis (M.S. in Management)--Naval Postgraduate School, June 1990.Cover title. Thesis Advisor(s): Eitelberg, Mark J. Second Reader: Mehay, Stephen. "June 2009." Description based on title screen as viewed on 19 October 2009. DTIC Identifier(s): Child care services, quality of life issues. Author(s) subject terms: Child care services, productivity, retention, quality of life issues. Includes bibliographical references (p. 197-199). Also available in print.
43
Ruggiano, Nicole. "Intergenerational human service delivery in the formal care industry / a case study." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 310 p, 2009. http://proquest.umi.com/pqdweb?did=1654499651&sid=2&Fmt=2&clientId=8331&RQT=309&VName=PQD.
Full text
44
Udedi, Michael Mphatso MacDonald. "Health service utilization by patients with common mental disorder identified by the SRQ-20 in a primary care setting in Zomba, Malawi : a descriptive study." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85581.
Full textAbstract:
Thesis (MPhil)-- Stellenbosch University, 2013.ENGLISH ABSTRACT: Background: Health service utilization by people with mental health problems seem to be a large public health issue, especially in low-income countries. In Malawi, the situation is not different from other developing countries in Sub-Saharan Africa as far as access to services for people with mental health problems is concerned. Non specialized health care workers provide mental health services in the primary care settings in Malawi and, given the workload at primary health care (PHC) setting level, little time is available to screen for mental disorders, hence these may go unrecognized. Therefore, there is a possibility that a significant proportion of patients attending primary care in Malawi may have common mental disorders (CMD) and may be deprived of routine screening. Consequently, the possibility of misdiagnosis may lead to higher service utilization by people with common mental health problems. However, no study has been carried out to assess the health service utilization by people with common mental disorders in Malawi. Aim: The aim of the study was to evaluate health services utilization patterns of patients with CMDs in primary care clinics. Methods: This was a quantitative study employing a cross-sectional descriptive design. The study was conducted in two primary health care clinics in one of the 28 districts in Malawi. The study included all consecutive patients aged 18 years and older who attended the primary health care clinics for any reason. Face-to-face interviews using the Self-Reporting Questionnaires (SRQ-20) were conducted in a sample of 323 primary health care attendees. Findings: The prevalence of probable CMD was 20.1%. People with CMD had a higher average number of health facility visits in the previous three months compared to those without probable CMD thus 1.6 vs. 1.19 (p-value 0.02). There was no significant difference in the average number of traditional healer visits in the previous three months between those with probable CMD and those without thus 0.05 vs. 0.08 (p-value = 0.565). The total average number of both health facility and traditional healer visits was 1.68 vs. 1.24 (p-value 0. 019), people with probable CMD having a higher average compared to those without a probable CMD. It was found that people who have visited the health care facility repeatedly in the past 3 months were likely to be suffering from CMD. The odds of probable CMD increased with each visit to a health facility by 1.2 (p-value=0.024). Almost all those who had probable CMD had no treatment prescribed for CMD by PHC clinicians. Conclusion: The study reveals high utilization of health services for people with CMD, as well as a treatment gap of mental health care in primary care settings. PHC workers are misdiagnosing patients with CMDs leading to high utilization of PHC services. There is need for PHC workers to improve skills in diagnosing patients with CMD to make PHC services more effective by reducing re-attendances and improving patient outcomes. There is also need to direct effort towards creating awareness about mental health and encourage patient disclosure of psychological or mental health problems.
AFRIKAANSE OPSOMMING: Agtergrond: Dit blyk dat veral in lae-inkomste lande, die gebruik van gesondheidsdienste onder mense met geestesgesondheidsprobleme `n kwellende gesondheidskwessie te wees. Malawi, soos ander ontwikkelende lande in Sub-Sahara Afrika, ervaar die probleem van toegang tot gesondheidsdienste vir mense met geestesgesondheidsprobleme. In die primêre gesondheidsdienste in Malawi, word pasiënte met geestesgesondheidsprobleme behandel, deur algemene gesondheidswerkers wat nie gespesialiseerd is in geestesgsondheid. Verder veroorsaak die arbeidslas in primêre gesondheidsorg dat daar nie altyd tyd is om pasiënte voldoende vir geestesgversteurings te ondersoek nie. Dit is daarom moontlik dat `n merkwaardige aantal pasiënte wat gebruik maak van primêre gesondheidsorg in Malawi aan algemene geestesversteurings lei, maar hulle word nie voldoende ondersoek nie en gevolglik word hulle of nie gediagnoseer nie of verkeerdelik gediagnoseer. Dit kan daartoe lei dat `n groter aantal pasiënte, met algemene geestesversteurings, gebruik maak van primêre gesondheidsdienste. Die probleem is dat daar nog geen navorsing in Malawi gedoen is, oor die gebruik van gesondheidsdienste onder mense met algemene geestesversteurings. Doelwit: Die doel van die studie is om pasiënte, met algemene geestesversteurings, se gebruik van primêre gesondheidsorg klinieke te ondersoek. Metodes: `n Dwarssnee kwantitatiewe beskrywende studie-ontwerp was gebruik. Data-insameling het by twee primêre gesondheidsorg klinieke, in een van die 28 distrikte in Malawi, plaasgevind. Pasiënte, 18-jaar en ouer, wat die primêre gesondheidsklinieke vir enige rede besoek het, was ingesluit in die studie. Die steekproef het bestaan uit 323 pasiënte wat gebruik gemaak het van primêre gesondheidsorg klinieke. Onderhoude was met pasiënte gevoer deur middel van `n self-relaas vraelys (ook verwys na as „Self-Reporting Questionnaires‟). Bevindinge: Daar was `n voorkomssyfer van 20.1% pasiënte wat waarskynlik aan algemene geestesversteurings gelei het. Mense wat waarskynlik aan algemene geestesversteurings gelei het, het in `n tydperk van drie maande gemiddeld meer gebruik gemaak van gesondheidsdienste, in vergelyking met diegene wat waarskynlik nie aan algemene geestesversteurings gelei het nie, dus 1.6 teenoor 1.19 (p-waarde van 0.02). In die gegewe drie maande was daar geen betekenisvolle verskil in die gemiddelde aantal besoeke afgelê aan tradisionele geneeshere deur pasiënte wat waarskynlik aan algemene geestesversteurings gelei het, in vergelyking met diegene wat waarskynlik nie aan geestesversteurings gelei het nie, dus 0.05 teenoor 0.08 (p-waarde= 0.565). In totaal het diegene met geestesversteuring ook gemiddeld meer besoeke, 1.68 teenoor 1.24 (p-waarde 0.019), aan beide gesondheidsorg en traditionele geneeshere afgelê het, as diegene wat waarskynlik nie aan geestesversteurings gelei het nie. Die bevindinge dui daarop dat mense wat in die afgelope drie maande herhaaldelik gebruik gemaak het van gesondheidsdienste, waarskynlik aan algemene geestesversteurings gelei het. Die moontlikheid dat `n pasiënt aan `n algemene geestesversteuring gelei het, het met 1.2 (p-waarde=0.024) verhoog met elke besoek aan die gesondheidsdienste. Byna al die pasiënte wat waarskynlik aan `n algemene geestesversteuring gelei het, het nie behandeling ontvang nie. Gevolgtrekking: Daar is bevind dat mense met algemene geestesversteurings geredelik gebruik maak van gesondheidsdienste en dat daar `n gaping is in die voorsiening van geestesgesondheidsdienste in primêre gesondheidsfasiliteite. Primêre gesondheidsorg personeel se hantering van pasiënte lei daartoe dat pasiënte met algemene geestesversteurings meer geredelik gebruik maak van primêre gesondheidsorg. Daar is `n behoefte aan die verbetering van primêre gesondheidsorg personeel se vaardighede en vermoë om pasiënte met geestesversteuring te diagnoseer en sodoende ook herhaaldelike besoeke te verminder en die gesondheidsuitkomste van pasiente te verbeter. Daar is `n behoefte aan groter bewusmaking van geestesgesondheid en om pasiënte aan te moedig om hulle sielkundige en geestesgesondheidsprobleme aan personeel te openbaar.
45
Lee-Jones, Lora. "Foster care and social work services from the perspective of the foster child." Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/3825.
Full text
46
Chowawa, Rosemary Shanice. "An evaluation of the implementation of capacity building strategies in the provision of health services in the central region of Malawi." Thesis, University of Fort Hare, 2012. http://hdl.handle.net/10353/d1007122.
Full textAbstract:
The purpose of the study was to evaluate the impact of implementing capacity building strategies on the provision of health services in the central region of Malawi. The study intended to determine why a lack of quality services is still prevailing in the health services in the central region despite implementing capacity building strategies aimed at improving the delivery of health services. In addition to this, to come up with recommendations to improve the implementation of the existing capacity building strategies so that the implementation results in the intended impact, that is efficient and effective provision of health services in the central region of Malawi. The studies reviewed what various scholars have written on capacity building in order to ground capacity building in Public Administration and provide the study with a conceptual, theoretical and legislative framework. This enabled the researcher to describe the nature and place of capacity building in Public Administration. It was evident from the review that the implementation of capacity building strategies is a systematic process which requires that chief officials follow all the steps in order to effectively and efficiently implement the capacity building strategies so that the intended impact is achieved. In this regard, capacity building is a management function which requires that chief officials play an enabling role by providing the necessary resources (both human and financial) and policies that support the implementation of capacity building strategies. The study used both quantitative and qualitative research methods whereby thirty-five respondents composed of political office-bearers and chief officials from Lilongwe, Dedza, Mchinji and Dowa districts and Ministry of Health Headquarters in the central region of Malawi were given self-administered questionnaires to complete. Face-to-face interviews and document analysis were also used as research methods. The intention was to determine the problems that are being experienced in the implementation of the existing capacity building strategies and find out if the strategies are resulting in the intended impact. The study findings confirmed that there are indeed problems being experienced in the implementation of the existing capacity building strategies, namely: inadequate human and financial resources, corruption, political interference, lack of consultation with stakeholders and lack of political will to make sure that the implementation of the capacity building strategies is effectively and efficiently done. It was also revealed that the implementation of the existing capacity building strategies is impacting negatively on the provision of health services in the central region of Malawi, hence indicating a need to change in approach. The study concludes that in order for the capacity building strategies to achieve the intended impact there is a need to broaden the scope of the legal framework on health capacity building strategies in Malawi, enforce the use of performance standards and improve the operational framework to gain efficiencies and effectiveness from current investments in capacity building.
47
Van, den Akker Thomas. "Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/12621.
Full textAbstract:
Includes bibliographical referencesBackground: In recent years there has been increasing debate about the impact of scaled-up ART and PMTCT programmes on the uptake and outcomes of reproductive health services, in particular the potential detrimental effects of HIV-care on the overall capacity of fragile health systems. The objective of this study was to evaluate changes in the uptake of reproductive health services as well as the main pregnancy outcomes during the scaling up of ART and PMTCT in Thyolo District, Malawi. Methods : Study design: retrospective descriptive district-wide cohort analysis for the period 2005 to 2009. Setting: Thyolo District, an area with around 600,000 inhabitants, an adult HIV-prevalence of 21% and a Total Fertility Rate of 5.7 in 2004. HIV-care including ART and PMTCT was scaled up since 2004 in Thyolo District to reach district-wide coverage in 2007. HIV-care is provided at district hospital, health centre and community health post levels. Outcomes: uptake of antenatal, intrapartum and postpartum care, family planning and treatment of sexually transmitted infections; infrastructural changes, and changes in maternal and perinatal pregnancy outcome. Data collection and analysis: data were collected from facility antenatal, intrapartum and postpartum records, as well as from MoH and MSF databases maintained for routine programme monitoring. Chisquare tests were performed comparing the baseline year (2005) with the year of study end (2009). Results: Uptake of peripartum care had improved markedly by the end of the five-year study period: the percentages of pregnant women who took up antenatal, intrapartum and postpartum care increased by 30%, 25% and 20% respectively. The number of family planning consultations increased by almost 50% and the number of women treated for sexually transmitted infections more than doubled. Interactions between HIV-care and general reproductive health care had positive effects on key health system components, including governance, health financing, human resources and drug supply. Reliable pregnancy outcome indicators for the entire observation period were difficult to obtain due to likely under-reporting of facility-based maternal and perinatal mortality. However, previously documented results from Thyolo show a reduction of facility-based severe maternal complications, including uterine rupture, between 2007 and 2009. Conclusions: Uptake of reproductive health services and facility-based maternal outcomes increased markedly during the period of HIV scale–up. This implies that the scale up of HIV-care did not inhibit, and likely increased, uptake of reproductive health services, while quality improvements in perinatal care could still be successfully implemented. The finding that ART and PMTCT care may be successfully integrated into broader reproductive health services with satisfying outcomes is a strong argument for continued scale up of ART and PMTCT in similar settings.
48
DeBord, Karen. "A comparison of two training models for the enhancement of quality of care for family child care providers." Diss., Virginia Tech, 1991. http://hdl.handle.net/10919/39773.
Full text
49
Kuronen, Marjo L. A. "The social organisation of motherhood : advice giving in maternity and child health care in Scotland and Finland." Thesis, University of Stirling, 1999. http://hdl.handle.net/1893/2302.
Full textAbstract:
This study is a qualitative, cross-cultural research on advice giving for mothers in maternity and child health services in Scotland and Finland. It has been accomplished through local case studies using ethnographic methods. The main objective is to analyse how in these service systems motherhood, women's daily life, and their responsibilities for children's welfare and health are defined and organised, and how these definitions vary across social and cultural contexts. Methodologically, referring to the feminist methodology by Dorothy E. Smith, it is emphasised that beginning from the local and particular, from the everyday practices of health professionals, can provide more general understanding of the social relations that organise motherhood in the two societies. Empirical results of the study are presented under six substantial themes: The first theme discusses different professional groups as service providers and the relationships between them. Second theme concentrates on the clinic and the home as the physical settings of service provision and their professional and cultural meanings. Third section discusses the relationship and interaction between health professionals and their clients. Next two themes are related to the standards of motherhood: expectations for proper motherhood, child care, and family relations of the mothers. The last theme analyses possible conflicts between women's everyday experience and professional expertise in motherhood. The general conclusions drawn from the research suggest that motherhood is socially organised at four different but interrelated levels, named in this study as interactional level, institutional level, welfare state level, and socio-cultural leveL. Advice giving for mothers in maternity and child health care is related to family policy measures, social class and gender systems, historical and cultural tradition, customs, and ways of thinking in a certain society. This complexity underlines the relevance of qualitative approach in comparative research.
50
Yeung, Kit-yi, and 楊潔儀. "The current issues facing the child and adolescent mental health care in Hong Kong: challenges of integratingprovision into primary care." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45175196.
Full text