Social capital and the utilization of maternal and child health services in India: A multilevel analysis

This study examines the association between social capital and the utilization of antenatal care, professional delivery care, and childhood immunizations using a multilevel analytic sample of 10,739 women who recently gave birth and 7,403 children between one and five years of age in 2,293 communities and 22 state-groups from the 2005 India Human Development Survey. Exploratory factor analysis was used to create and validate six social capital measures that were used in multilevel logistic regression models to examine whether each form of social capital had an independent, contextual effect on health care use. Results revealed that social capital operated at the community level in association with all three care-seeking behaviors; however, the results differed based on the type of health care utilized. Specifically, components of social capital that led to heterogeneous bridging ties were positively associated with all three types of health care use, whereas components of social capital that led to strong bonding ties were negatively associated with use of preventive care, but positively associated with professional delivery care

Social Capital and Health in the Developing World: Meaning, Mechanisms, and Measurement

The overall goal of this dissertation is to contribute to the understanding of community-based development by exploring the relationship between social capital and health in the developing world. Distinct methodological approaches were applied to each chapter of this dissertation to examine (1) the association between social capital and physical health in the least developed countries, (2) the content validity of the measurement of social capital in Bangladesh, and (3) the relationship between different components of social capital and the utilization of maternal and child health services in India. The study described in Chapter 2 used a systematic literature review process to show that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to elucidate the mechanisms through which social capital affects health in the developing world. Chapter 3 used expert reviews, focus group discussions, and cognitive interviews to create a newly adapted social capital survey instrument for use by health and development organizations in Bangladesh. This study highlighted the importance of using cognitive interviews to ensure respondents are able to comprehend key terms, recall important information, and identify appropriate responses about social capital. Chapter 4 used exploratory factor analysis and multilevel logistic regression models to demonstrate that social capital operates at the community level in association with the utilization of antenatal care, professional delivery care, and childhood immunizations in India. Specifically, components of social capital that led to heterogeneous bridging ties were positively associated with all three types of health services, whereas components of social capital that led to strong bonding ties were negatively associated with use of preventive care, but positively associated with professional delivery care. Taken together, these three studies emphasized the theoretical and operational complexity of the concept of social capital and the importance of distinguishing between different components of social capital in order to understand their differential association with health behaviors. Policy implications include the need to develop innovative ways to strengthen community-level aspects of social relationships (social capital), while also making contributions to social resources available to individuals within communities (human and economic capital).PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/99772/1/wstory_1.pd

Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa

We assess how countries in regions of the world where maternal mortality is highest - South Asia and Sub-Saharan Africa - are performing with regards to providing women with vital elements of the continuum of care

Obstetric care among refugee populations: reinforcing cultural humility in residency training—preliminary report

The burden of increasing obstetric morbidity and mortality in the United States disproportionately impacts certain populations more than others, one such group being refugees. Poor obstetric outcomes among refugee communities historically have been attributed to delayed initiation of prenatal care, failure to detect co-morbidities, as well as higher rates of Cesarean sections (C-sections), stillbirths, pre-term births, and low birth weight infants in comparison to host-country mothers. Therefore, understanding the contextual nuances that play a role in these poor outcomes among refugee populations is very important

Residual-Ion Orientation After Autoionization

We have measured the relative population in the two mj states of barium 6p1/2 ions produced by the autoionization of (6p3/2nd)J=MJ=3 states by detecting the helicity of the emitted fluorescence. These populations can be related to the relative branching ratio into the 6p1/2εd5/2 and 6p1/2εg7/2 continuum channels. Rydberg states with n=16-23 have similar branching ratios, producing approximately six times as much 6p1/2εd5/2 population as 6p1/2εg7/2 population

Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms

Abstract Background In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerous barriers to institutional delivery exist including financial, physical, cognitive, organizational, and psychological and social. This study examines the psychological and social barriers to institutional delivery, namely women’s decision-making autonomy and their perceptions about social support for institutional delivery in their community. Methods This study uses cross-sectional data collected for the evaluation of the Maternal and Newborn Referrals Project of Project Fives Alive in Northern and Central districts of Ghana. In 2012 and 2013, a total of 2,527 women aged 15 to 49 were surveyed at baseline and midterm (half in 2012 and half in 2013). The analysis sample of 1,606 includes all women who had a birth three years prior to the survey date and who had no missing data. To determine the relationship between institutional delivery and the two key social barriers—women’s decision-making autonomy and community perceptions of institutional delivery—we used multi-level logistic regression models, including cross-level interactions between community-level attitudes and individual-level autonomy. All analyses control for the clustered survey design by including robust standard errors in Stata 13 statistical software. Results The findings show that women who are more autonomous and who perceive positive attitudes toward facility delivery (among women, men and mothers-in-law) were more likely to deliver in a facility. Moreover, the interactions between autonomy and community-level perceptions of institutional delivery among men and mothers-in-law were significant, such that the effect of decision-making autonomy is more important for women who live in communities that are less supportive of institutional delivery compared to communities that are more supportive. Conclusions This study builds upon prior work by using indicators that provide a more direct assessment of perceived community norms and women’s decision-making autonomy. The findings lead to programmatic recommendations that go beyond individuals and engaging the broader network of people (husbands and mothers-in-law) that influence delivery behaviors

Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms

Abstract Background In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerous barriers to institutional delivery exist including financial, physical, cognitive, organizational, and psychological and social. This study examines the psychological and social barriers to institutional delivery, namely women’s decision-making autonomy and their perceptions about social support for institutional delivery in their community. Methods This study uses cross-sectional data collected for the evaluation of the Maternal and Newborn Referrals Project of Project Fives Alive in Northern and Central districts of Ghana. In 2012 and 2013, a total of 2,527 women aged 15 to 49 were surveyed at baseline and midterm (half in 2012 and half in 2013). The analysis sample of 1,606 includes all women who had a birth three years prior to the survey date and who had no missing data. To determine the relationship between institutional delivery and the two key social barriers—women’s decision-making autonomy and community perceptions of institutional delivery—we used multi-level logistic regression models, including cross-level interactions between community-level attitudes and individual-level autonomy. All analyses control for the clustered survey design by including robust standard errors in Stata 13 statistical software. Results The findings show that women who are more autonomous and who perceive positive attitudes toward facility delivery (among women, men and mothers-in-law) were more likely to deliver in a facility. Moreover, the interactions between autonomy and community-level perceptions of institutional delivery among men and mothers-in-law were significant, such that the effect of decision-making autonomy is more important for women who live in communities that are less supportive of institutional delivery compared to communities that are more supportive. Conclusions This study builds upon prior work by using indicators that provide a more direct assessment of perceived community norms and women’s decision-making autonomy. The findings lead to programmatic recommendations that go beyond individuals and engaging the broader network of people (husbands and mothers-in-law) that influence delivery behaviors

Husbands' involvement in delivery care utilization in rural Bangladesh: A qualitative study

Abstract Background A primary cause of high maternal mortality in Bangladesh is lack of access to professional delivery care. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women's access to and utilization of professional maternal health services that can prevent maternal mortality. This qualitative study examines husbands' involvement during childbirth and professional delivery care utilization in a rural sub-district of Netrokona district, Bangladesh. Methods Using purposive sampling, ten households utilizing a skilled attendant during the birth of the youngest child were selected and matched with ten households utilizing an untrained traditional birth attendant, or dhatri. Households were selected based on a set of inclusion criteria, such as approximate household income, ethnicity, and distance to the nearest hospital. Twenty semi-structured interviews were conducted in Bangla with husbands in these households in June 2010. Interviews were transcribed, translated into English, and analyzed using NVivo 9.0. Results By purposefully selecting households that differed on the type of provider utilized during delivery, common themes--high costs, poor transportation, and long distances to health facilities--were eliminated as sufficient barriers to the utilization of professional delivery care. Divergent themes, namely husbands' social support and perceived social norms, were identified as underlying factors associated with delivery care utilization. We found that husbands whose wives utilized professional delivery care provided emotional, instrumental and informational support to their wives during delivery and believed that medical intervention was necessary. By contrast, husbands whose wives utilized an untrained dhatri at home were uninvolved during delivery and believed childbirth should take place at home according to local traditions. Conclusions This study provides novel evidence about male involvement during childbirth in rural Bangladesh. These findings have important implications for program planners, who should pursue culturally sensitive ways to involve husbands in maternal health interventions and assess the effectiveness of education strategies targeted at husbands.http://deepblue.lib.umich.edu/bitstream/2027.42/112942/1/12884_2011_Article_487.pd

Validating the Measurement of Social Capital in Bangladesh: A Cognitive Approach

Despite the growing evidence linking social capital to improvements in health and health behaviors, reliable measures of social capital are lacking in low-income countries. To accurately measure social capital in new contexts, there is a need to validate social capital survey questions in each new cultural setting. In this article we examine the content validity of the measurement of social capital in Bangladesh using qualitative methods. In December 2012, we conducted four focus group discussions and 32 cognitive interviews in one rural subdistrict (Durgapur) and one urban slum (Mirpur). We used the findings from the focus groups and cognitive interviews to create a new social capital survey instrument that can be used by health and development organizations in Bangladesh. Furthermore, in this article we provide insight into social capital survey research in general, including suggestions for the measurement of group membership, social support, collective action, and social trust

Primary Care Practice Addressing Child Overweight and Obesity: A Survey of Primary Care Physicians at Four Clinics in Southern Appalachia

Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings. Methods: A 61-item healthcare provider questionnaire assessing current practices, attitudes, perceived barriers, and skill levels in managing childhood overweight and obesity was distributed to physicians in four primary care clinics. Questionnaires were obtained from 36 physicians. Results: Physicians\u27 practices to address childhood overweight and obesity were limited, despite the fact that most physicians shared the attitude that childhood overweight and obesity need attention. While 71% of physicians reported talking about eating and physical activity habits with parents of overweight or obese children, only 19% reported giving these parents the tools they needed to make changes. Approximately 42% determined the parents\u27 readiness to make small changes for their overweight or obese children. Physicians\u27 self-perceived skill level in managing childhood overweight and obesity was found to be a key factor for childhood overweight- and obesity- related practices. Conclusion: Primary care physicians in southern Appalachia currently play a limited role in the prevention or intervention of childhood overweight and obesity. Training physicians to improve their skills in managing childhood overweight and obesity may lead to an improvement in practice