Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study

<p>Abstract</p> <p>Background</p> <p>Maternal health is one of the major worldwide health challenges. Currently, the unacceptably high levels of maternal mortality are a common subject in global health and development discussions. Although some countries have made remarkable progress, half of the maternal deaths in the world still take place in Sub-Saharan Africa where little or no progress has been made. There is no single simple, straightforward intervention that will significantly decrease maternal mortality alone; however, there is a consensus on the importance of a strong health system, skilled delivery attendants, and women's rights for maternal health. Our objective was to describe and determine different factors associated with the maternal mortality ratio in Sub-Saharan countries.</p> <p>Methods</p> <p>An ecological multi-group study compared variables between many countries in Sub-Saharan Africa using data collected between 1997 and 2006. The dependent variable was the maternal mortality ratio, and Health care system-related, educational and economic indicators were the independent variables. Information sources included the WHO, World Bank, UNICEF and UNDP.</p> <p>Results</p> <p>Maternal mortality ratio values in Sub-Saharan Africa were demonstrated to be high and vary enormously among countries. A relationship between the maternal mortality ratio and some educational, sanitary and economic factors was observed. There was an inverse and significant correlation of the maternal mortality ratio with prenatal care coverage, births assisted by skilled health personnel, access to an improved water source, adult literacy rate, primary female enrolment rate, education index, the Gross National Income per capita and the per-capita government expenditure on health.</p> <p>Conclusions</p> <p>Education and an effective and efficient health system, especially during pregnancy and delivery, are strongly related to maternal death. Also, macro-economic factors are related and could be influencing the others.</p

Sustainable intensification – “oxymoron” or “third-way”? A systematic review

Sustainable Intensification (SI) is a term that has been advanced to capture a concept that some consider as the ‘third paradigm’ for global agricultural development. However, the term has become subject to intense debates as well as scepticism and confusion regarding its meaning and the characteristics of production systems that could indicate SI (defined as “indicators”). This has resulted in a proliferation of literature. We have conducted a systematic review of a sample of this literature analysing the most commonly suggested indicators of SI in order to investigate the extent to which the critiques of SI are valid in their viewpoints that SI is an oxymoron, underpinned by a productivist agenda, and to identify the critical issues in the development of a comprehensive and unambiguous set of SI indicators. From 633 articles identified by a search of relevant databases, a sample of 75 articles were selected and analysed using the NVIVO™ software. The results were organised according to a Socio-Ecological Systems (SES) framework comprising seven sub-systems or components − resource system, resource units, governance system, resource users, interactions, outcomes, and environment. A total of 218 indicators (both positive and negative) were identified. Most of these indicators focused on the ‘outcomes’ of agricultural systems with the majority being related to agricultural production. Few indicators were identified as relating to the economic and societal dimensions of food systems. Whilst this potentially suggested a productivist bias in the current interpretation of SI it was difficult to draw a black and white conclusion, since for the other system components, the majority of the indicators suggested appeared to take a more holistic point-of-view and emphasised both productivity and sustainability of agricultural systems. Our analysis suggests that a key reason why SI may be viewed with scepticism is a lack of specificity and elucidation of the rationale, scale, and farm type for which SI is proposed. Moreover, a number of the indicators were so loosely defined that the interventions they imply could be enacted without due consideration of the social impacts of their adoption. We conclude that there is need to develop SI indicators according to specific farming types and scales and also with more consideration of the social and political dimensions of food systems in order to promote a constructive dialogue around the concept of SI to take place. Unless the concept of SI is described and measured in such a holistic and inclusive manner, it is unlikely to be accepted as a valid descriptor of sought-after agricultural practices by players in the Third Sector

Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: strengthening outcome indicators

There are number of Non-Governmental Organisations (NGOs) in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/ AIDS and an official from Sport Recreation South Africa (SRSA). Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour. The selected NGOs can adapt the proposed generic outcomes and indicators based on the settings of their programmes. A collaborative approach by all stakeholders is required, from international organisations, funders, governments, NGOs and communities to strengthening monitoring and evaluation of sport-based HIV/AIDS awareness programmes including other development programmes. This will assist the NGOs that use sport for development to be able to reflect accurately the information about their HIV/AIDS activities and also be able to contribute to on-going monitoring activities at a national and global level as well as to the Sustainable Development Goals.IS

Towards a multi-criteria approach for priority setting: an application to Ghana.

Contains fulltext : 51079.pdf (publisher's version ) (Closed access)BACKGROUND: Many criteria have been proposed to guide priority setting in health, but their relative importance has not yet been determined in a way that allows a rank ordering of interventions. METHODS: In an explorative study, a discrete choice experiment was carried out to determine the relative importance of different criteria in identifying priority interventions in Ghana. Thirty respondents chose between 12 pairs of scenarios that described interventions in terms of medical and non-medical criteria. Subsequently, a composite league table was constructed to rank order a set of interventions by mapping interventions on those criteria and considering the relative weights of different criteria. RESULTS: Interventions that are cost-effective, reduce poverty, target severe diseases, or target the young had a higher probability of being chosen than others. The composite league table showed that high priority interventions in Ghana are prevention of mother to child transmission in HIV/AIDS control, and treatment of pneumonia and diarrhoea in childhood. Low priority interventions are certain interventions to control blood pressure, tobacco and alcohol abuse. The composite league table lead to a different and more differentiated rank ordering of interventions compared to pure efficiency ratings. CONCLUSION: This explorative study has introduced a multi-criteria approach to priority setting. It has shown the feasibility of accounting for efficiency, equity and other societal concerns in prioritization decisions, and its potentially large impact on priority setting