An adaptive household sampling method for rural African communities

Investigators working in rural communities and small towns in Africa face many obstacles to obtaining a random and representative sample of households for their research. The civic infrastructure used as the building blocks of survey sampling in developed countries are mostly absent in rural Africa. The purpose of the study described in this paper was to pilot an innovative and cost-effective approach to household sampling designed to generate probability samples representative of the socio-economic diversity of the small town of Berekuso, in the Eastern Region of Ghana, without relying on existing census data, household registers, or a regular layout of roads and dwellings. Utilizing Google Earth images and a Graphical Information System (GIS) map of Berekuso, sampling units were defined as 15-degree wedge-shaped sectors radiating from the center of the original township. All households within randomly selected sectors were surveyed, and based on a household classification scheme, each household type was identified. Additional sectors were randomly selected and surveyed in sequence until no new household types were identified – a notion recognized by laboratory scientists as an ‘end point’. The adaptive sampling strategy was cost and time effective: freely available versions of Google Earth and QGIS software were employed along with inexpensive handheld Global Positioning System (GPS) devices; a total of 57 households were surveyed by teams of two enumerators over three consecutive Sundays. The survey method yielded a probability sample that is representative of the socioeconomic diversity of Berekuso, and produced generalizable results for median household size, median age of residents, sources of potable water and toilet types, among others. For example, based on the results of the survey, a 95% confidence interval estimate of the proportion of residents of Berekuso under the age of 20 years is between 0.49 and 0.58. These figures are consistent with results of Ghana’s 2010 census which pegged the proportion of the population of the Eastern Region under the age of the 20 years at 0.49. The authors believe that the methodology described in this paper may be applicable to household research in many rural African villages and small towns where little civic infrastructure exists to create more traditional sampling frames.Key words: Google Earth, area sampling, household survey, impact evaluation, wealth rankin

An adaptive household sampling method for rural African communities

Part of the Berekuso Impact StudyInvestigators working in rural communities and small towns in Africa face many obstacles to obtaining a random and representative sample of households for their research. The civic infrastructure used as the building blocks of survey sampling in developed countries are mostly absent in rural Africa. The purpose of the study described in this paper was to pilot an innovative and cost-effective approach to household sampling designed to generate probability samples representative of the socio-economic diversity of the small town of Berekuso, in the Eastern Region of Ghana, without relying on existing census data, household registers, or a regular layout of roads and dwellings. Utilizing Google Earth images and a Graphical Information System (GIS) map of Berekuso, sampling units were defined as 15-degree wedge-shaped sectors radiating from the center of the original township. All households within randomly selected sectors were surveyed, and based on a household classification scheme, each household type was identified. Additional sectors were randomly selected and surveyed in sequence until no new household types were identified – a notion recognized by laboratory scientists as an‘end point’. The adaptive sampling strategy was cost and time effective: freely available versions of Google Earth and QGIS software were employed along with inexpensive handheld Global Positioning System (GPS) devices; a total of 57 households were surveyed by teams of two enumerators over three consecutive Sundays. The survey method yielded a probability sample that is representative of the socioeconomic diversity of Berekuso, and produced generalizable results for median household size, median age of residents, sources of potable water and toilet types, among others. For example, based on the results of the survey, a 95% confidence interval estimate of the proportion of residents of Berekuso under the age of 20 years is between 0.49 and 0.58. These figures are consistent with results of Ghana’s 2010 census which pegged the proportion of the population of the Eastern Region under the age of the 20 years at 0.49. The authors believe that the methodology described in this paper may be applicable to household research in many rural African villages and small towns where little civic infrastructure exists to create more traditional sampling frames.Ashesi University Colleg

Social research on neglected diseases of poverty: Continuing and emerging themes

Copyright: © 2009 Manderson et al.Neglected tropical diseases (NTDs) exist and persist for social and economic reasons that enable the vectors and pathogens to take advantage of changes in the behavioral and physical environment. Persistent poverty at household, community, and national levels, and inequalities within and between sectors, contribute to the perpetuation and re-emergence of NTDs. Changes in production and habitat affect the physical environment, so that agricultural development, mining and forestry, rapid industrialization, and urbanization all result in changes in human uses of the environment, exposure to vectors, and vulnerability to infection. Concurrently, political instability and lack of resources limit the capacity of governments to manage environments, control disease transmission, and ensure an effective health system. Social, cultural, economic, and political factors interact and influence government capacity and individual willingness to reduce the risks of infection and transmission, and to recognize and treat disease. Understanding the dynamic interaction of diverse factors in varying contexts is a complex task, yet critical for successful health promotion, disease prevention, and disease control. Many of the research techniques and tools needed for this purpose are available in the applied social sciences. In this article we use this term broadly, and so include behavioral, population and economic social sciences, social and cultural epidemiology, and the multiple disciplines of public health, health services, and health policy and planning. These latter fields, informed by foundational social science theory and methods, include health promotion, health communication, and heath education

Towards a Framework for Understanding Ethnic Consumers' Acculturation Strategies in a Multicultural Environment: A Food Consumption Perspective

© Bidit Lal Dey, Sharifah Alwi, Fred Yamoah, Stephanie Agyepongmaa Agyepong, Hatice Kizgin andMeera Sarma. Purpose – While it is essential to further research the growing diversity in Western metropolitan cities, little is currently known about how the members of various ethnic communities acculturate to multicultural societies. The purpose of this paper is to explore immigrants’ cosmopolitanism and acculturation strategies through an analysis of the food consumption behaviour of ethnic consumers in multicultural London. Design/Methodology/Approach – The study was set within the socio-cultural context of London. A number of qualitative methods such as in-depth interviews, observation and photographs were used to assess consumers’ acculturation strategies in a multicultural environment and how that is influenced by consumer cosmopolitanism. Findings – Ethnic consumers’ food consumption behaviour reflects their acculturation strategies, which can be classified into four groups: rebellion, rarefaction, resonance and refrainment. This classification demonstrates ethnic consumers’ multi-directional acculturation strategies, which are also determined by their level of cosmopolitanism. Research implications/limitations – The taxonomy presented in this paper advances current acculturation scholarship by suggesting a multi-directional model for acculturation strategies as opposed to the existing uni-directional and bi-directional perspectives and explicates the role of consumer cosmopolitanism in consumer acculturation. The paper did not engage host communities and there is hence a need for future research on how and to what extent host communities are acculturated to the multicultural environment. Practical implications – The findings have direct implications for the choice of standardization versus adaptation as a marketing strategy within multicultural cities. Whilst the rebellion group are more likely to respond to standardization, increasing adaptation of goods and service can ideally target members of the resistance and resonance groups and more fusion products should be exclusively earmarked for the resonance group. Originality/Value – The paper makes original contribution by introducing a multi-directional perspective to acculturation by delineating four-group taxonomy (rebellion, rarefaction, resonance and refrainment). This paper also presents a dynamic model that captures how consumer cosmopolitanism impinges upon the process and outcome of multi-directional acculturation strategies

Building the field of health policy and systems research: framing the questions.

In the first of a series of articles addressing the current challenges and opportunities for the development of Health Policy & Systems Research (HPSR), Kabir Sheikh and colleagues lay out the main questions vexing the field

Building the Field of Health Policy and Systems Research: An Agenda for Action

In the final article in a series addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR), Sara Bennett and colleagues lay out an agenda for action moving forward

"Even if the test result is negative, they should be able to tell us what is wrong with us": a qualitative study of patient expectations of rapid diagnostic tests for malaria.

BACKGROUND: The debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability. METHODS: This qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result. RESULTS: Patients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis. CONCLUSIONS: Improvements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses

Who sleeps under bednets in Ghana? A doer/non-doer analysis of malaria prevention behaviours

BACKGROUND: Malaria prevention programmes should be based in part on knowledge of why some individuals use bednets while others do not. This paper identifies factors and characteristics of women that affect bednet use among their children less than five years of age in Ghana. METHODS: Data come from the baseline component of an evaluation of Freedom from Hunger's malaria curriculum. A quasi-experimental design was used to select clients (n = 516) of Credit with Education (an integrated package of microfinance and health education) and non-clients (n = 535). Chi-squares, Fisher's Exact tests and logistic regression were used to compare the characteristics of mothers whose children use bednets (doers) with those whose children do not (non-doers) and to identify factors associated with bednet use among children less than five years of age. RESULTS: The following factors were most closely associated with bednet use: region of residence; greater food security; and caregivers' beliefs about symptoms, causation and groups most vulnerable to malaria. Most respondents knew mosquitoes caused malaria; however, 20.6% of doers and 12.3% of non-doers (p = .0228) thought overworking oneself caused malaria. Ninety percent of doers and 77.0% of non-doers felt that sleeping under a net was protective against malaria (p = .0040). In addition, 16.5% of doers and 7.5% of non-doers (p = .0025) identified adult males as most vulnerable to malaria. CONCLUSION: Greater knowledge about malaria does not always translate into improved bednet use. Though culturally-based ideas about malaria may vary between communities, integrating them into traditional health education messages may enhance the effectiveness of public health efforts

Socially-marketed rapid diagnostic tests and ACT in the private sector: ten years of experience in Cambodia.

Whilst some populations have recently experienced dramatic declines in malaria, the majority of those most at risk of Plasmodium falciparum malaria still lack access to effective treatment with artemisinin combination therapy (ACT) and others are already facing parasites resistant to artemisinins.In this context, there is a crucial need to improve both access to and targeting of ACT through greater availability of good quality ACT and parasitological diagnosis. This is an issue of increasing urgency notably in the private commercial sector, which, in many countries, plays an important role in the provision of malaria treatment. The Affordable Medicines Facility for malaria (AMFm) is a recent initiative that aims to increase the provision of affordable ACT in public, private and NGO sectors through a manufacturer-level subsidy. However, to date, there is little documented experience in the programmatic implementation of subsidized ACT in the private sector. Cambodia is in the unique position of having more than 10 years of experience not only in implementing subsidized ACT, but also rapid diagnostic tests (RDT) as part of a nationwide social marketing programme. The programme includes behaviour change communication and the training of private providers as well as the sale and distribution of Malarine, the recommended ACT, and Malacheck, the RDT. This paper describes and evaluates this experience by drawing on the results of household and provider surveys conducted since the start of the programme. The available evidence suggests that providers' and consumers' awareness of Malarine increased rapidly, but that of Malacheck much less so. In addition, improvements in ACT and RDT availability and uptake were relatively slow, particularly in more remote areas.The lack of standardization in the survey methods and the gaps in the data highlight the importance of establishing a clear system for monitoring and evaluation for similar initiatives. Despite these limitations, a number of important lessons can still be learnt. These include the importance of a comprehensive communications strategy and of a sustained and reliable supply of products, with attention to the geographical reach of both. Other important challenges relate to the difficulty in incentivising providers and consumers not only to choose the recommended drug, but to precede this with a confirmatory blood test and ensure that providers adhere to the test results and patients to the treatment regime. In Cambodia, this is particularly complicated due to problems inherent to the drug itself and the emergence of artemisinin resistance