Build the cradle later: An examination of perinatal care and mortality in village nepal.

Background: As perinatal and neonatal mortality move to the foreground of the debate on how best to improve child survival in poor countries, there appears a pressing need to test potential interventions. Implicit in testing is the ability to document birth and neonatal outcomes in rural communities. The thesis sets perinatal events in the context of the child survival literature and critically examines current knowledge about practices, outcomes and interventions. This knowledge is found to be limited, particularly in terms of practices and outcomes in rural settings in developing countries. Methods: Two methods are described to document perinatal events in villages in Makwanpur district, Nepal. (1) a census of women of reproductive age, collecting information about previous pregnancies and most recent live births (2) a prospective system of registration that tracked women through childbirth and infants through the neonatal period. Both methods yielded information on pregnancies, birth outcomes, care practices and health care seeking patterns. Results: The census collected information from 12,170 women, of whom 4867 had given birth in the preceding two years. The prospective surveillance collected information on 3522 pregnancies over two years. The thesis presents results under two broad themes: (1) a description of the birth experience of women in rural Makwanpur, its outcomes, practices and care seeking patterns (2) a comparison of the two methods of data collection. Poverty was the norm in rural Makwanpur and only a quarter of participants were literate. 30% of pregnant women had any antenatal care, which tended to be both late and limited, and 95% gave birth at home. Three percent of women were helped by trained health workers and there were compromises in hygiene and warmth at the time of delivery. Breastfeeding rates were high. The prospective registration process suggested a neonatal mortality rate of 37 per thousand live births, a figure higher than that from the census (27 per thousand), and thus higher than would be estimated by existing methodologies. Discussion: Antenatal, delivery, postnatal and neonatal care practices and care seeking are compared with existing knowledge from other studies. Their implications for programmatic intervention are considered. The issue of recall-based data collection is discussed as it bears upon the evaluation of public health interventions. The feasibility of registration systems is assessed and recommendations made for increasing reliability, expansion and replication, and reducing system costs. 386 words

PENGGUNAAN MEDIA AUDIO VISUAL UNTUK MENINGKATKAN HASIL BELAJAR SISWA KELAS II SEKOLAH DASAR PADA PEMBELAJARAN ILMU PENGETAHUAN SOSIAL

Penelitian ini dilatar belakangi oleh tingkat hasil belajar siswa yang masih sangat rendah. Sebagian besar siswa beranggapan bahwa pelajaran Ilmu Pengetahuan Sosial adalah pelajaran yang membosankan dan cukup menyulitkan sehingga berdampak pada hasil belajar siswa. Hal ini terjadi karena pembelajaran yang monoton dan kurang kreatifnya guru untuk berinovasi dalam penggunaan media pembelajaran. Berdasarkan hasil penelitian yang peniliti dapatkan diketahui bahwa kesulitan yang dialami siswa dalam pembelajarn ilmu Pengetahuan Sosial bukan hanya dilatar belakangi oleh guru yang kurang kreatif dalam penggunaan media pembelajaran tetapi dilatar belakangi juga kurangnya atau tidak adanya motivasi dan minat siswa dalam pelajaran Ilmu Pengetahuan Sosial karena siswa menganggap bahwa pelajaran IPS merupakan pelajaran hafalan yang tidak menarik. Dengan demikian perlu adanya penggunaan media pembelajaran yang tepat sehingga meningkatkan motivasi dan meningkatkan hasil belajar siswa dalam pelajaran Ilmu Pengetahuan Sosial. Penelitian ini difokuskan pada peningkatan hasil belajar siswa siswa dengan menggunakan media audio visual. Tujuan dari penelitian ini adalah untuk mengetahui pelaksanaan dan peningkatan hasil belajar siswa terhadap pelajarn Ilmu Pengetahuan Sosial. Metode yang digunakan adalah metode Penelitian Tindakan Kelas (PTK) yang mengadaptasi model Kemmis dan Mc Taggart yang berupa spiral penelitian penelitian tindakan kelas dimana tahapnya meliputi empat tahap, yaiti: 1). Perencanaan tindakan; 2).pelaksanaan tindakan; 3). Pengamatan (observasi); 4). Refleksi serta pengumpulan data dilakukan melalui lembar observasi lembar observasi guru dan tes evaluasi siswa. Berdasarkan hasil penelitian disimpulkan bahwa tingkat hasil belajar siswa pembelajaran Ilmu Pengetahuan Sosial pada kelas II meningkat pada setiap siklusnya. Dimana nilai rata-rata siswa pada siklus I yaitu 66,72% sedangkan nilai rata-rata pada siklus II yaitu 99,46%. Hal ini, menunjukan bahwa hasil belajar siswa mengalami peningkatan setelah menggunakan media audio visual. Oleh karena itu, penulis menyarankan untuk menggunakan media pembelajaran yang tepat sehingga dapat menarik minat siswa terhadap pembelajaran Ilmu Pengetahuan Sosial

Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: a systematic review.

The partograph is a graphic display of the progress of labour, recommended by the World Health Organization, but often underused in practice in low- and middle-income countries. We were interested in going beyond demonstration of potential efficacy - on which the existing literature concentrates - through a systematic review to identify barriers to and incentives for achieving partograph use

Mixed studies review of domestic violence in the lives of women affected by HIV stigma

We conducted a mixed studies review to examine domestic violence and stigma against women affected by HIV. We searched Medline, Web of Science, PsycINFO and EMBASE databases with no starting date limit. Studies that reported on experiences of stigma, discrimination, or domestic violence against women affected by HIV in any country were included. Because the review focused on HIV stigma-related violence, we only included studies that reported violence following an HIV diagnosis or at the time of HIV testing. A total 1056 records were screened; 89 articles were assessed for full text eligibility and 49 studies were selected for evidence synthesis. A convergent approach was used and study findings were analysed thematically. Four broad themes emerged: (1) being affected by HIV increases domestic violence, (2) supportive reactions from partners, (3) HIV stigma is associated with domestic violence, and (4) domestic violence associated with HIV-stigma is gendered. Research gaps identified included the burden of intersectional stigma of domestic violence and HIV, and the mediating role of HIV stigma in domestic violence for women with HIV, highlighting the need for further research in this area to reduce violence against women living with HIV

Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai

Background: Aggregate urban health statistics mask inequalities. We described maternity care in vulnerable slum communities in Mumbai, and examined differences in care and outcomes between more and less deprived groups. Methods: We collected information through a birth surveillance system covering a population of over 280 000 in 48 vulnerable slum localities. Resident women identified births in their own localities and mothers and families were interviewed at 6 weeks after delivery. We analysed data on 5687 births over one year to September 2006. Socioeconomic status was classified using quartiles of standardized asset scores. Results: Women in higher socioeconomic quartile groups were less likely to have married and conceived in their teens (Odds ratio 0.74, 95% confidence interval 0.69–0.79, and 0.82, 0.78–0.87, respectively). There was a socioeconomic gradient away from public sector maternity care with increasing socioeconomic status (0.75, 0.70–0.79 for antenatal care and 0.66, 0.61–0.71 for institutional delivery). Women in the least poor group were five times less likely to deliver at home (0.17, 0.10–0.27) as women in the poorest group and about four times less likely to deliver in the public sector (0.27, 0.21–0.35). Rising socioeconomic status was associated with a lower prevalence of low birth weight (0.91, 0.85–0.97). Stillbirth rates did not vary, but neonatal mortality rates fell non-significantly as socioeconomic status increased (0.88, 0.71–1.08). Conclusion: Analyses of this type have usually been applied across the population spectrum from richest to poorest, and we were struck by the regularly stepped picture of inequalities within the urban poor, a group that might inadvertently be considered relatively homogeneous. The poorest slum residents are more dependent upon public sector health care, but the regular progression towards the private sector raises questions about its quality and regulation. It also underlines the need for healthcare provision strategies to take account of both sectors

Body composition in Nepalese children using isotope dilution: the production of ethnic-specific calibration equations and an exploration of methodological issues.

Background. Body composition is important as a marker of both current and future health. Bioelectrical impedance (BIA) is a simple and accurate method for estimating body composition, but requires population-specific calibration equations. Objectives. (1) To generate population specific calibration equations to predict lean mass (LM) from BIA in Nepalese children aged 7-9 years. (2) To explore methodological changes that may extend the range and improve accuracy. Methods. BIA measurements were obtained from 102 Nepalese children (52 girls) using the Tanita BC-418. Isotope dilution with deuterium oxide was used to measure total body water and to estimate LM. Prediction equations for estimating LM from BIA data were developed using linear regression, and estimates were compared with those obtained from the Tanita system. We assessed the effects of flexing the arms of children to extend the range of coverage towards lower weights. We also estimated potential error if the number of children included in the study was reduced. Findings. Prediction equations were generated, incorporating height, impedance index, weight and sex as predictors (R (2) 93%). The Tanita system tended to under-estimate LM, with a mean error of 2.2%, but extending up to 25.8%. Flexing the arms to 90° increased the lower weight range, but produced a small error that was not significant when applied to children <16 kg (p 0.42). Reducing the number of children increased the error at the tails of the weight distribution. Conclusions. Population-specific isotope calibration of BIA for Nepalese children has high accuracy. Arm position is important and can be used to extend the range of low weight covered. Smaller samples reduce resource requirements, but leads to large errors at the tails of the weight distribution

Understanding diversion programmes as an intervention for women with mental health issues: A realist review

Purpose: Women in prisons are known to suffer with more mental health difficulties and many experience challenges prior to incarceration. Diversion programmes are initiatives designed to divert people with pre-existing mental illness from the criminal justice system into mental health services. The variability of effectiveness of interventions makes realist approaches particularly appropriate for diversion programmes, and this paper presents the first realist review to be undertaken across the breadth of this topic. This realist review aimed to explain the successes, failures and partial successes of these programmes as an intervention to improve the outcomes of women offenders with mental health issues.// Methods: We conducted a realist review of published literature explaining the impact of diversion programmes on participants with mental health issues. Consultations with six specialists in the field were conducted to validate the principles and hypotheses about key dynamics for effective programmes. // Results: The review included 69 articles. We identified four essential principles, developed through thematic groupings of context-mechanism-outcome configurations, to articulate key drivers of the effectiveness of diversion programmes: coordination between services; development and maintenance of relationships; addressing major risk factors; and stabilisation through diversion programmes. // Conclusions: The behaviour of women offenders is driven by need, and the complex needs of this group require individualised plans that incorporate relationships as vehicles for support and change. Although there is a role for gender-specific interventions, it is not fully understood and further research is required. Implications for future interventions are discussed

Prevalence, pattern, and predictors of formal help-seeking for intimate partner violence against women: findings from India's cross-sectional National Family Health Surveys-3 (2005-2006) and 4 (2015-2016)

BACKGROUND: Help-seeking for intimate partner violence (IPV) requires women to disclose their experiences. For policymakers, low help-seeking threatens the United Nations Sustainable Development Goals (SDGs) of gender equality, good health, and wellbeing. In India, the Prevention of Domestic Violence Against Women Act (PWDVA 2005) was implemented in 2006. Using two rounds of the India National Family Health Survey (NFHS), one before and one after implementation, we examined the prevalence, pattern, and sociodemographic and socioeconomic factors associated with formal help-seeking for IPV. METHODS: We used univariable and multivariable logistic regression models to assess the prevalence of help-seeking for IPV in the past 12 months and examined associations with different forms of IPV and sociodemographic factors. RESULTS: The proportion of ever-married women aged 15-49 years who reported physical, sexual, or emotional IPV in the last 12 months increased from 23% in NFHS-3 (2005-2006) to 25% in NFHS-4 (2015-2016). In both surveys, few women sought help. Informal sources of help were preferred over formal sources, which declined from NFHS-3 to NFHS-4 (any help: 24.5 to 13.8%; informal help: 24.1 to 13.4%; and formal help: 1.2 to 1.1%). Women from lower castes and women with children were less likely to seek formal help. Over the two surveys, the odds of formal help-seeking for sexual IPV in the past 12 months remained similar (NFHS-3 aOR 1.9, 95% CI 1.4, 2.5. NFHS-4 aOR 1.9, 95% CI 1.4, 2.6). The odds were slightly higher for emotional IPV (NFHS-3 aOR 2.5, 95% CI 1.8, 3.3. NFHS-4 aOR 2.7, 95% CI 2.0, 3.7) and spousal control (NFHS-3 aOR 2.0, 95% CI 1.4, 3.0. NFHS-4 aOR 2.3, 95% CI: 1.4, 3.7). CONCLUSIONS: Low disclosure and help-seeking impact a country's social, cultural, economic, and political progress. The PWDVA did not appear to result in increases in help-seeking among women in India who experienced IPV. Further work is needed to understand barriers to help-seeking in the presence of public policy efforts to support women affected by IPV. These may include poor implementation and enforcement of Policy, as well as normalization and justification of gender-based violence. We recommend a deeper understanding of help-seeking across all systems to establish a barometer of help-seeking. An increase in formal or informal help-seeking is an indicator of reduced tolerance of IPV and the enabling environment of the PWDVA 2005 for tracking progress toward the SDGs of gender equality and the eradication of all forms of gender-based violence and discrimination