Combating Infant Mortality in Rural India: Evidence from a Field Study of eHealth Kiosk Imlementations

The United Nations’ Millennium Development Goals listed high infant mortality rates as a major problem in developing countries, especially in rural areas. Given the powerful information dissemination capabilities, information and communication technologies (ICTs) have been suggested as interventions to build infant care awareness and to modify healthcare behaviors. We examine how the use of one ICT intervention—specifically, eHealth kiosks disseminating authenticated and accessible medical information—can alleviate the problem of high infant mortality in rural India. We investigate how mothers’ social networks affect their use of eHealth kiosks, seeking professional medical care for their infants and, ultimately, infant mortality. Drawing on the social epidemiology and social networks literatures, we focus on advice and hindrance from both strong and weak ties as the conduit of social influence on mothers’ health-related behaviors for the care of their infants. Over a period of 7 years, we studied 4,620 infants across 10 villages where the eHealth kiosks were implemented along with support resources for proxy use. The results revealed that (1) eHealth kiosk use promotes seeking professional medical care and reduces infant mortality, (2) mothers are especially vulnerable to hindrance from both strong and weak ties as they choose to maintain the status quo of traditional infant healthcare practices (e.g., reliance on untrained personnel, superstitions, fatalism) in villages, and (3) advice from both strong and weak ties offers the potential to break down misplaced beliefs about infant healthcare practices and to develop literacy on seeking professional medical care. In contrast, in a comparative group of 10 neighboring villages, the reduction in infant mortality was not as pronounced and the effect of professional medical care in reducing infant mortality was lower. Our findings suggest that an ICT intervention can effectively address one of society’s most important problems (i.e., infant mortality) even in parts of the world with limited resources and deep suspicion of technology and change. Overall, we believe such an ICT intervention will complement other investments being made, including the facilitation of use (proxy use) and provision of professional medical facilities to reduce infant mortality

Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania.

Child mortality remains one of the major public-health problems in Tanzania. Delays in receiving and accessing adequate care contribute to these high rates. The literature on public health often focuses on the role of mothers in delaying treatment, suggesting that they contact the health system too late and that they prefer to treat their children at home, a perspective often echoed by health workers. Using the three-delay methodology, this study focus on the third phase of the model, exploring the delays experienced in receiving adequate care when mothers with a sick child contact a health-care facility. The overall objective is to analyse specific structural factors embedded in everyday practices at health facilities in a district in Tanzania which cause delays in the treatment of poor children and to discuss possible changes to institutions and social technologies. The study is based on qualitative fieldwork, including in-depth interviews with sixteen mothers who have lost a child, case studies in which patients were followed through the health system, and observations of more than a hundred consultations at all three levels of the health-care system. Data analysis took the form of thematic analysis. Focusing on the third phase of the three-delay model, four main obstacles have been identified: confusions over payment, inadequate referral systems, the inefficient organization of health services and the culture of communication. These impediments strike the poorest segment of the mothers particularly hard. It is argued that these delaying factors function as 'technologies of social exclusion', as they are embedded in the everyday practices of the health facilities in systematic ways. The interviews, case studies and observations show that it is especially families with low social and cultural capital that experience delays after having contacted the health-care system. Reductions of the various types of uncertainty concerning payment, improved referral practices and improved communication between health staff and patients would reduce some of the delays within health facilities, which might feedback positively into the other two phases of delay

Already at a disadvantage? ICT in the home and children's preparation for primary school. (ICT Research Bursaries 2004 - Final Report)

The aim of this study is to investigate the impact of socio-economic disadvantage on pre-school children's development of competences in information and communications technologies (ICT). The study focuses on children's experiences of ICT in the home and in pre-school settings in the year before they begin formal education, and seeks to investigate concepts of advantage and disadvantage in this context. The study also aims to investigate teachers' perceptions of children's ICT competences on entry to school

"Mothers as Candy Wrappers": Critical Infrastructure Supporting the Transition into Motherhood

Copyright © ACM. The transition into motherhood is a complicated and often unsupported major life disruption. To alleviate mental health issues and to support identity re-negotiation, mothers are increasingly turning to online mothers\u27 groups, particularly private and secret Facebook groups; these can provide a complex system of social, emotional, and practical support for new mothers. In this paper we present findings from an exploratory interview study of how new mothers create, find, use, and participate in ICTs, specifically online mothers\u27 groups, to combat the lack of formal support systems by developing substitute networks. Utilizing a framework of critical infrastructures, we found that these online substitute networks were created by women, for women, in an effort to fill much needed social, political, and medical gaps that fail to see \u27woman and mother\u27 as a whole being, rather than simply as a \u27discarded candy wrapper\u27. Our study contributes to the growing literature on ICT use by mothers for supporting and negotiating new identities, by illustrating how these infrastructures can be re-designed and appropriated in use, for critical utilization

Digital identities: tracing the implications for learners and learning

This is the fourth in a series of seminars, funded by the Economic and Social Research Council, to examine ‘The educational and social impact of new technologies on young people in Britain’. Its purpose is to bring together academics, policy makers and practitioners from many different backgrounds in order to consider the contexts and consequences of use of new information and communication technologies for children and young people, with a particular focus on the implications on technological change on formal and informal education. The series is coordinated by John Coleman, Ingrid Lunt, Chris Davies and myself, together with guidance from our advisory board – Keri Facer, Neil Selwyn and Ros Sutherland

Acceptability – a neglected dimension of access to health care : findings from a study on childhood convulsions in rural Tanzania

ABSTRACT: BACKGROUND: Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the premise that a match between health providers' and clients' understanding of disease is an important dimension of social acceptability, especially in trans-cultural communication, for example if childhood convulsions are not linked with malaria and local treatment practices are mostly preferred. The study was linked to health interventions with the objective of bridging the gap between local and biomedical understanding of convulsions. METHODS: The study combined classical ethnography with the cultural epidemiology approach using EMIC (Explanatory Model Interview Catalogue) tool. EMIC interviews were conducted in a 2007/08 convulsion study (n = 88) and results were compared with those of an earlier 2004/06 convulsion study (n = 135). Earlier studies on convulsion in the area were also examined to explore longer-term changes in treatment practices. RESULTS: The match between local and biomedical understanding of convulsions was already high in the 2004/06 study. Specific improvements were noted in form of (1) 46% point increase among those who reported use of mosquito nets to prevent convulsion (2) 13% point decrease among caregivers who associated convulsion with 'evil eye and sorcery', 3) 14% point increase in prompt use of health facility and 4)16% point decrease among those who did not use health facility at all. Such changes can be partly attributed to interventions which explicitly aimed at increasing the match between local and biomedical understanding of malaria. Caregivers, mostly mothers, did not seek advice on where to take an ill child. This indicates that treatment at health facility has become socially acceptable for severe febrile with convulsion. CONCLUSION: As an important dimension of access to health care 'social acceptability' seems relevant in studying illnesses that are perceived not to belong to the biomedical field, specifically in trans-cultural societies. Understanding the match between local and biomedical understanding of disease is fundamental to ensure acceptability of health care services, successful control and management of health problems. Our study noted some positive changes in community knowledge and management of convulsion episodes, changes which might be accredited to extensive health education campaigns in the study area. On the other hand it is difficult to make inference out of the findings as a result of small sample size involved. In return, it is clear that well ingrained traditional beliefs can be modified with communication campaigns, provided that this change resonates with the beneficiaries

Transgressive technologies? Strategies of discursive containment in the representation and regulation of assisted reproductive technologies in Aotearoa/New Zealand

Drawing on a case study of the contemporary representation and regulation of assisted reproductive technologies (ARTs) in Aotearoa/New Zealand, this article traces the cultural anxieties evident in public, political, and media discussion and debate around the provision and use of ART, with a specific focus on the use of donor insemination and IVF by single women and lesbian couples. It documents the operation of various narrative mechanisms, normative assumptions, and discursive strategies that work to identify the legitimate uses and users of such technologies whilst simultaneously affirming conventional understandings of "gender", "motherhood", and "the family", and concludes that contemporary anxieties and ethical dilemmas provoked by women's transgressive uses of ART have been addressed through legislative changes that target certain groups of women for official surveillance and control while also effectively limiting their reproductive options