Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory.

BackgroundMistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients' reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients' perception of the quality of care is dependent, not only on the content of care, but importantly, on women's expectations of care.MethodsThis study uses rich, mixed-methods data to explore women's characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women's social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women.ResultsQuantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge.ConclusionsLack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care

Assessing the Opportunities and Challenges in the Transition to Computer-Based Survey Data Collection: The Role of Key Software System Features

This report examines the opportunities and challenges associated with the adoption of computer-assisted interviewing (CAI) technology for data collection in household surveys in the Indian context, following a recent large-scale test of CAI in the southern Indian state of Tamil Nadu. The issues identified are highly relevant to the Government of Tamil Nadu’s (GOTN) ongoing work to convert state survey data collection operations to CAI. These issues are also more generally informative to the shift from paper-based questionnaire instruments to CAI technology for state governments throughout India. The Survey Research Center (SRC) at the University of Michigan has worked closely with a Tamil Nadu state government agency—the Department of Economics and Statistics—that is at the center of this shift to CAI. Based on this experience, and our background running major CAI surveys in the U.S., Nepal, China, and elsewhere, this report provides some broader context about CAI, key features to consider in the selection of CAI software platforms, issues in the management of CAI operations, and related topics. This report was prepared by SRC independently of GOTN, but in service of the GOTN’s work to expand CAI data collection.World Bankhttp://deepblue.lib.umich.edu/bitstream/2027.42/171096/1/WB Report Transition to CAPI FINAL 2021-02-27.pdfDescription of WB Report Transition to CAPI FINAL 2021-02-27.pdf : Technical ReportSEL

Effects of proactive vs fixed community health care delivery on child health and access to care: a cluster randomised trial secondary endpoint analysis

BACKGROUND: Professional community health workers (CHWs) can help achieve universal health coverage, although evidence gaps remain on how to optimise CHW service delivery. We conducted an unblinded, parallel, cluster randomised trial in rural Mali to determine whether proactive CHW delivery reduced mortality and improved access to health care among children under five years, compared to passive delivery. Here we report the secondary access endpoints. METHODS: Beginning from 26-28 February 2017, 137 village-clusters were offered care by CHWs embedded in communities who were trained, paid, supervised, and integrated into a reinforced public-sector health system that did not charge user fees. Clusters were randomised (stratified on primary health centre catchment and distance) to care during CHWs during door-to-door home visits (intervention) or based at a fixed village site (control). We measured outcomes at baseline, 12-, 24-, and 36-month time points with surveys administered to all resident women aged 15-49 years. We used logistic regression with cluster-level random effects to estimate intention-to-treat and per-protocol effects over time on prompt (24-hour) treatment within the health sector. RESULTS: Follow-up surveys between February 2018 and April 2020 generated 20 105 child-year observations. Across arms, prompt health sector treatment more than doubled compared to baseline. At 12 months, children in intervention clusters had 22% higher odds of receiving prompt health sector treatment than those in control (cluster-specific adjusted odds ratio (aOR) = 1.22; 95% confidence interval (CI) = 1.06, 1.41, P = 0.005), or 4.7 percentage points higher (adjusted risk difference (aRD) = 0.047; 95% CI = 0.014, 0.080). We found no evidence of an effect at 24 or 36 months. CONCLUSIONS: CHW-led health system redesign likely drove the 2-fold increase in rapid child access to care. In this context, proactive home visits further improved early access during the first year but waned afterwards. REGISTRATION: ClinicalTrials.gov NCT02694055

Migration and early childhood health in Cambodia: A mixed-methods analysis

As migration rates rise globally, this population change has profound health consequences, including for children left behind. The degree to which migration advantages or disadvantages children’s health is determined in part by factors such as migrant parents’ ability to remit, children’s living arrangements in the face of parental absence, and caregiver characteristics, among others. The migration and child health literature has largely failed to examine care-seeking processes and child health behaviors, important dimensions of children’s well-being that are likely influenced by parental out-migration. Moreover, it has generally excluded skipped-generation households, an increasingly prevalent living arrangement that may have specific implications for the health and well-being of children. I address these gaps using a mixed-methods approach that leverages data from Cambodia, a high-migration setting. Using qualitative data, I identify the social process of care seeking for children’s health in skipped-generation households, including familial dynamics for decision-making, the agency of and constraints faced by grandparent caregivers, and the role of absent migrant parents. I find migration shifts familial roles whereby grandparents direct care seeking for children, but face distinct barriers to care. I use three waves of the Cambodia Socio-Economic Survey to examine whether families invest remittances in their children’s health. I use an instrumental variables approach to estimate whether acutely ill children whose households receive remittances are more likely to attend care with quality providers than children in non-migrant households. I find no evidence that remittances affect children’s access to curative care. Finally, I use four waves of the Cambodia Demographic and Health Survey to examine how children’s living arrangements associate with acute malnutrition in a period of increasing migration. I find children in skipped-generation households consistently experienced lower odds of acute malnutrition compared to children in nuclear families and other types of households. However, this relative advantage diminished over time as the diversity of children’s living arrangements increased. Together, these analyses illuminate the multiple mechanisms through which parents’ out-migration shapes their children’s access to care, and the strategies migrant-sending families employ to manage children’s health. This dissertation highlights the importance of understanding demographic context for child health interventions and policies

Drought and migration: An analysis of the effects of drought on temporary labor and return migration from a migrant-sending area in Nepal.

Although the relationship between drought - a dimension of climate change - and migration has been explored in a number of settings, prior research has largely focused on out-migration and has not considered climate factors at the migrant destination. However, drought may impact not only out-migration, but also return migration, particularly in settings where temporary labor migration and agricultural reliance are common. Thus, considering drought conditions at origin and destinations is necessary to specify the effects of climate on migrant-sending populations. Using detailed data from the Chitwan Valley Family Study, a household panel study in a migrant-sending area in Nepal, we analyze the effect of drought at the neighborhood level on individual-level out-migration and drought at the origin district on return migration among adults from 2011 to 2017, assessing these associations among males and females separately. In mixed-effect discrete-time regressions, we find that neighborhood drought is positively associated with out-migration and return migration, both internally and internationally among males. Among females, drought is positively associated with internal out-migration and return migration, but not international migrations. We did not find an association between drought at the origin and return migration independent of drought status at the destination. Taken together, these findings contribute to our understanding of the complexity of the impacts of precipitation anomalies on population movement over time

La Charente

26 mars 18871887/03/26 (A16,N5813)-1887/03/26.Appartient à l’ensemble documentaire : PoitouCh

Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory.

BackgroundMistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients' reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients' perception of the quality of care is dependent, not only on the content of care, but importantly, on women's expectations of care.MethodsThis study uses rich, mixed-methods data to explore women's characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women's social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women.ResultsQuantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge.ConclusionsLack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care

The association between timing in pregnancy of drought and excess rainfall, infant sex, and birthweight: Evidence from Nepal

BackgroundPast research on the impact of climatic events, such as drought, on birth outcomes has primarily been focused in Africa, with less research in South Asia, including Nepal. Existing evidence has generally found that drought impacts birthweight and infant sex, with differences by trimester. Additionally, less research has looked at the impact of excess rain on birth outcomes or focused on the impact of rainfall extremes in the preconception period. Using data from a large demographic surveillance system in Nepal, combined with a novel measure of drought/excess rainfall, we explore the impact of these on birthweight by time in pregnancy.MethodsUsing survey data from the 2016 to 2019 Chitwan Valley Study in rural Nepal combined with data from Climate Hazards InfraRed Precipitation with Station, we explored the association between excess rainfall and drought and birthweight, looking at exposure in the preconception period, and by trimester of pregnancy. We also explore the impact of excess rainfall and drought on infant sex and delivery with a skilled birth attendant. We used multilevel regressions and explored for effect modification by maternal age.ResultsDrought in the first trimester is associated with lower birthweight (β = -82.9 g; 95% confidence interval [CI] = 164.7, -1.2) and drought in the preconception period with a high likelihood of having a male (odds ratio [OR] = 1.41; 95% CI = 1.01, 2.01). Excess rainfall in the first trimester is associated with high birthweight (β = 111.6 g; 95% CI = 20.5, 202.7) and higher odds of having a male (OR = 1.48; 95% CI = 1.02, 2.16), and in the third trimester with higher odds of low birth weight (OR = 2.50; 95% CI = 1.40, 4.45).ConclusionsIncreasing rainfall extremes will likely impact birth outcomes and could have implications for sex ratios at birth