Noor Muhammad M Ansari - Academia.edu (original) (raw)
Papers by Noor Muhammad M Ansari
African Educational Research Journal, 2018
This paper analyzes data collected in the 2013 Liberian Annual School Census undertaken as part o... more This paper analyzes data collected in the 2013 Liberian Annual School Census undertaken as part of the Educational Management Information System and supplemented by information gathered from teacher education program organizers as well as from samples of graduates from preservice and inservice C-Certificate granting programs undertaken in Liberia in during 2007 to 2013. The authors report that the percentage of "qualified" primary school teachers (that is, those with at least a C-Certificate, which Liberian policy sets as the minimum qualification) expanded dramatically after the education system was decimated during the years of civil war (1989 to 2003). We also indicate that in government primary schools in 2013, the pupil-teacher ratio (24.8) and even the pupil-qualified teacher ratio (36.2) was lower-that is, betterthan the policy goal of 44 pupils per teacher. However, teacher hiring and deployment decisions led to large inequalities in these input measures of educational quality. At the same time, the authors discovered that the findings from the analysis of Liberia's 2013 EMIS data did not fully answer the question of where the (qualified) teachers are, in that we were not able to locate in the EMIS database substantial numbers of graduates of the various C-Certificate teacher education programs. However, contrary to the EMIS database findings, when telephone interviews were conducted with samples of these graduates, it was learned that many, but not the majority, of them had been employed in the education sector in 2013. The sources of this inaccuracy include: a) the principals of some schools had not been invited to the workshop where they were oriented to filling out the Annual School Census questionnaire; b) some principals, who attended, did not return the questionnaire; and c) some female and male teachers had used different names when enrolled in the C-Certificate program than they were using as teachers in 2013. The authors conclude by discussing the implications of the limitations of the EMIS data for reporting key indicators in Liberia and in other countries in relation to monitoring the global Sustainable Development Goal #4.
Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is par... more Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy. Method: In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and su...
African Educational Research Journal
This paper analyzes data collected in the 2013 Liberian Annual School Census undertaken as part o... more This paper analyzes data collected in the 2013 Liberian Annual School Census undertaken as part of the Educational Management Information System and supplemented by information gathered from teacher education program organizers as well as from samples of graduates from preservice and inservice C-Certificate granting programs undertaken in Liberia in during 2007 to 2013. The authors report that the percentage of "qualified" primary school teachers (that is, those with at least a C-Certificate, which Liberian policy sets as the minimum qualification) expanded dramatically after the education system was decimated during the years of civil war (1989 to 2003). We also indicate that in government primary schools in 2013, the pupil-teacher ratio (24.8) and even the pupil-qualified teacher ratio (36.2) was lower-that is, betterthan the policy goal of 44 pupils per teacher. However, teacher hiring and deployment decisions led to large inequalities in these input measures of educational quality. At the same time, the authors discovered that the findings from the analysis of Liberia's 2013 EMIS data did not fully answer the question of where the (qualified) teachers are, in that we were not able to locate in the EMIS database substantial numbers of graduates of the various C-Certificate teacher education programs. However, contrary to the EMIS database findings, when telephone interviews were conducted with samples of these graduates, it was learned that many, but not the majority, of them had been employed in the education sector in 2013. The sources of this inaccuracy include: a) the principals of some schools had not been invited to the workshop where they were oriented to filling out the Annual School Census questionnaire; b) some principals, who attended, did not return the questionnaire; and c) some female and male teachers had used different names when enrolled in the C-Certificate program than they were using as teachers in 2013. The authors conclude by discussing the implications of the limitations of the EMIS data for reporting key indicators in Liberia and in other countries in relation to monitoring the global Sustainable Development Goal #4.
International Journal of Educational Development, 2009
Violence Against Women, 2009
This article describes the first national survey of violence against women in Pakistan from 2001 ... more This article describes the first national survey of violence against women in Pakistan from 2001 to 2004 covering 23,430 women. The survey took account of methodological and ethical recommendations, ensuring privacy of interviews through one person interviewing the mother-in-law while another interviewed the eligible woman privately. The training module for interviewers focused on empathy with respondents, notably increasing disclosure rates. Only 3% of women declined to participate, and 1% were not permitted to participate. Among women who disclosed physical violence, only one third had previously told anyone. Surveys of violence against women in Pakistan not using methods to minimize underreporting could seriously underestimate prevalence.
Patient Education and Counseling, 2008
Objective: Demonstrate the effective use of community-based evidence for health promotion by Lady... more Objective: Demonstrate the effective use of community-based evidence for health promotion by Lady Health Workers (LHWs) in Sindh, Pakistan. Methods: A baseline study on mothers and children provided local evidence for risk communication tools designed and tested by LHWs. The communities were randomized to intervention and control. LHWs visited women before and after childbirth to discuss safe practices in pregnancy, in the intervention group LHW using the new tools and in the control group using their standard procedures. A household survey and focus groups permitted assessment of the impact of the intervention. Results: Women in the intervention communities were more likely to attend prenatal checkups, to stop routine heavy work during pregnancy, to give colostrum to newborn babies, and to maintain exclusive breastfeeding for four months. Community focus groups confirmed a positive reaction to the tools. Conclusion: Discussion by lay health workers of local evidence underlying safe motherhood messages improved uptake of protective health practices. Practice implications: Door-to-door health promotion based on culturally appropriate interaction around relevant evidence can have a positive impact on health practices. Engaging health workers from the onset builds capacities, improves dialogue within the health system and performance of frontline health workers.
Journal of Interpersonal Violence, 2010
Worldwide, many women who experience domestic violence keep their experience secret. Few report t... more Worldwide, many women who experience domestic violence keep their experience secret. Few report to official bodies. In a national survey of abuse against women in Pakistan, we examined factors related to disclosure: women who had experienced physical violence telling someone about it. In focus groups, we explored why women do not report domestic violence. Nearly one third of the 23,430 women interviewed had experienced physical violence. Only 35% of them had told anyone about it, almost always someone within their own family. Several personal and family factors were associated with disclosure. Having discussed the issue and feeling empowered to discuss violence were consistent associations. Of the 7,895 women who had suffered physical violence, only 14 had reported the matter to the police. Female focus groups said women who report violence risk their reputation and bring dishonor to the family; women fear reporting violence because it may exacerbate the problem and may lead to sepa...
BMC Health Services Research, 2011
Background: In rebuilding devastated health services, the government of Afghanistan has provided ... more Background: In rebuilding devastated health services, the government of Afghanistan has provided access to basic services mainly by contracting with non-government organisations (NGOs), and more recently the Strengthening Mechanism (SM) of contracting with Provincial Health Offices. Community-based information about the public's views and experience of health services is scarce. Methods: Field teams visited households in a stratified random sample of 30 communities in two districts in Kabul province, with health services mainly provided either by an NGO or through the SM and administered a questionnaire about household views, use, and experience of health services, including payments for services and corruption. They later discussed the findings with separate community focus groups of men and women. We calculated weighted frequencies of views and experience of services and multivariate analysis examined the related factors. Results: The survey covered 3283 households including 2845 recent health service users. Some 42% of households in the SM district and 57% in the NGO district rated available health services as good. Some 63% of households in the SM district (adjacent to Kabul) and 93% in the NGO district ordinarily used government health facilities. Service users rated private facilities more positively than government facilities. Government service users were more satisfied in urban facilities, if the household head was not educated, if they had enough food in the last week, and if they waited less than 30 minutes. Many households were unwilling to comment on corruption in health services; 15% in the SM district and 26% in the NGO district reported having been asked for an unofficial payment. Despite a policy of free services, one in seven users paid for treatment in government facilities, and three in four paid for medicine outside the facilities. Focus groups confirmed people knew payments were unofficial; they were afraid to talk about corruption. Conclusions: Households used government health services but preferred private services. The experience of service users was similar in the SM and NGO districts. People made unofficial payments in government facilities, whether SM or NGO run. Tackling corruption in health services is an important part of anti-corruption measures in Afghanistan.
BMC Health Services Research, 2011
Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is par... more Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy. Method: In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering. Findings: The most consistent and prominent of 28 candidate risk factors and underlying determinants for nonfatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5). Interpretation: Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their livesgenital mutilation, domestic violence, and steep power gradientsis accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.
BMC Health Services Research, 2011
Background: The government of Pakistan introduced devolution in 2001. Responsibility for delivery... more Background: The government of Pakistan introduced devolution in 2001. Responsibility for delivery of most health services passed from provincial to district governments. Two national surveys examined public opinions, use, and experience of health services in 2001 and 2004, to assess the impact of devolution on these services from the point of view of the public. Methods: A stratified random cluster sample drawn in 2001 and revisited in 2004 included households in all districts. Field teams administered a questionnaire covering views about available health services, use of government and private health services, and experience and satisfaction with the service. Focus groups in each community discussed reasons behind the findings, and district nazims (elected mayors) and administrators commented about implementation of devolution. Multivariate analysis, with an adjustment for clustering, examined changes over time, and associations with use and satisfaction with services in 2004. Results: Few of 57,321 households interviewed in 2002 were satisfied with available government health services (23%), with a similar satisfaction (27%) among 53,960 households in 2004. Less households used government health services in 2004 (24%) than in 2002 (29%); the decrease was significant in the most populous province. In 2004, households were more likely to use government services if they were satisfied with the services, poorer, or less educated. The majority of users of government health services were satisfied; the increase from 63% to 67% between 2002 and 2004 was significant in two provinces. Satisfaction in 2004 was higher among users of private services (87%) or private unqualified practitioners (78%). Users of government services who received all medicines from the facility or who were given an explanation of their condition were more likely to be satisfied. Focus groups explained that people avoid government health services particularly because of bad treatment from staff, and unavailable or poor quality medicines. District nazims and administrators cited problems with implementation of devolution, especially with transfer of funds. Conclusions: Under devolution, the public did not experience improved government health services, but devolution was not fully implemented as intended. An ongoing social audit process could provide a basis for local and national accountability of health services.
… and Training (CIET) …, 2005
Contents List of tables............................................................................. more Contents List of tables..................................................................................................................... iii List of boxes........................................................................... ... ... Services provided by the district government......................................................................67 Agriculture services ............................ ...
![Research paper thumbnail of Household cost-benefit equations and sustainable universal childhood immunisation: a randomised cluster controlled trial in south Pakistan [ISRCTN12421731]](https://attachments.academia-assets.com/73530309/thumbnails/1.jpg)
](Background: Household decision-makers decide about service use based largely on the costs and per... more Background: Household decision-makers decide about service use based largely on the costs and perceived benefits of health interventions. Very often this leads to different decisions than those imagined by health planners, resulting in under-utilisation of public services like immunisation. In the case of Lasbela district in the south of Pakistan, only one in every ten children is immunised despite free immunisation offers by government health services. Methods/design: In 32 communities representative of Lasbela district, 3344 households participated in a baseline survey on early child health. In the 18 randomly selected intervention communities, we will stimulate discussions on the household cost-benefit equation, as measured in the baseline. The reference (control) communities will also participate in the three annual followup surveys, feedback of the general survey results and the usual health promotion activities relating to immunisation, but without focussed discussion on the household cost-benefit equations. Discussion: This project proposes knowledge translation as a two-way communication that can be augmented by local and international evidence. We will document cultural and contextual barriers to immunisation in the context of household cost-benefit equations. The project makes this information accessible to health managers, and reciprocally, makes information on immunisation effects and side effects available to communities. We will measure the impact of this two-way knowledge translation on immunisation uptake. Background Despite billions of dollars spent on childhood immunisation, some countries have never reached universal childhood immunisation (UCI), and many more have been unable to sustain it. An estimated 1.5 million deaths under 5 years of age can be prevented by vaccination each
BMC International Health and Human Rights, 2009
BACKGROUND: Rates of childhood vaccination in Pakistan remain low.There is continuing debate abou... more BACKGROUND: Rates of childhood vaccination in Pakistan remain low.There is continuing debate about the role of consumer and service factors in determining levels of vaccination in developing countries. METHODS: In a stratified random cluster sample of census enumeration areas across four districts in Pakistan, household interviews about vaccination of children and potentially related factors with 10,423 mothers of 14,542 children
BMC International Health and Human Rights, 2009
BACKGROUND: Achieving equity means increased uptake of health services for those who need it most... more BACKGROUND: Achieving equity means increased uptake of health services for those who need it most. But the poorest families continue to have the poorest service. In Pakistan, large numbers of children do not access vaccination against measles despite the national government's effort to achieve universal coverage. METHODS: A cross-sectional study of a random sample of 23 rural and 9 urban
African Educational Research Journal, 2018
This paper analyzes data collected in the 2013 Liberian Annual School Census undertaken as part o... more This paper analyzes data collected in the 2013 Liberian Annual School Census undertaken as part of the Educational Management Information System and supplemented by information gathered from teacher education program organizers as well as from samples of graduates from preservice and inservice C-Certificate granting programs undertaken in Liberia in during 2007 to 2013. The authors report that the percentage of "qualified" primary school teachers (that is, those with at least a C-Certificate, which Liberian policy sets as the minimum qualification) expanded dramatically after the education system was decimated during the years of civil war (1989 to 2003). We also indicate that in government primary schools in 2013, the pupil-teacher ratio (24.8) and even the pupil-qualified teacher ratio (36.2) was lower-that is, betterthan the policy goal of 44 pupils per teacher. However, teacher hiring and deployment decisions led to large inequalities in these input measures of educational quality. At the same time, the authors discovered that the findings from the analysis of Liberia's 2013 EMIS data did not fully answer the question of where the (qualified) teachers are, in that we were not able to locate in the EMIS database substantial numbers of graduates of the various C-Certificate teacher education programs. However, contrary to the EMIS database findings, when telephone interviews were conducted with samples of these graduates, it was learned that many, but not the majority, of them had been employed in the education sector in 2013. The sources of this inaccuracy include: a) the principals of some schools had not been invited to the workshop where they were oriented to filling out the Annual School Census questionnaire; b) some principals, who attended, did not return the questionnaire; and c) some female and male teachers had used different names when enrolled in the C-Certificate program than they were using as teachers in 2013. The authors conclude by discussing the implications of the limitations of the EMIS data for reporting key indicators in Liberia and in other countries in relation to monitoring the global Sustainable Development Goal #4.
Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is par... more Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy. Method: In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and su...
African Educational Research Journal
This paper analyzes data collected in the 2013 Liberian Annual School Census undertaken as part o... more This paper analyzes data collected in the 2013 Liberian Annual School Census undertaken as part of the Educational Management Information System and supplemented by information gathered from teacher education program organizers as well as from samples of graduates from preservice and inservice C-Certificate granting programs undertaken in Liberia in during 2007 to 2013. The authors report that the percentage of "qualified" primary school teachers (that is, those with at least a C-Certificate, which Liberian policy sets as the minimum qualification) expanded dramatically after the education system was decimated during the years of civil war (1989 to 2003). We also indicate that in government primary schools in 2013, the pupil-teacher ratio (24.8) and even the pupil-qualified teacher ratio (36.2) was lower-that is, betterthan the policy goal of 44 pupils per teacher. However, teacher hiring and deployment decisions led to large inequalities in these input measures of educational quality. At the same time, the authors discovered that the findings from the analysis of Liberia's 2013 EMIS data did not fully answer the question of where the (qualified) teachers are, in that we were not able to locate in the EMIS database substantial numbers of graduates of the various C-Certificate teacher education programs. However, contrary to the EMIS database findings, when telephone interviews were conducted with samples of these graduates, it was learned that many, but not the majority, of them had been employed in the education sector in 2013. The sources of this inaccuracy include: a) the principals of some schools had not been invited to the workshop where they were oriented to filling out the Annual School Census questionnaire; b) some principals, who attended, did not return the questionnaire; and c) some female and male teachers had used different names when enrolled in the C-Certificate program than they were using as teachers in 2013. The authors conclude by discussing the implications of the limitations of the EMIS data for reporting key indicators in Liberia and in other countries in relation to monitoring the global Sustainable Development Goal #4.
International Journal of Educational Development, 2009
Violence Against Women, 2009
This article describes the first national survey of violence against women in Pakistan from 2001 ... more This article describes the first national survey of violence against women in Pakistan from 2001 to 2004 covering 23,430 women. The survey took account of methodological and ethical recommendations, ensuring privacy of interviews through one person interviewing the mother-in-law while another interviewed the eligible woman privately. The training module for interviewers focused on empathy with respondents, notably increasing disclosure rates. Only 3% of women declined to participate, and 1% were not permitted to participate. Among women who disclosed physical violence, only one third had previously told anyone. Surveys of violence against women in Pakistan not using methods to minimize underreporting could seriously underestimate prevalence.
Patient Education and Counseling, 2008
Objective: Demonstrate the effective use of community-based evidence for health promotion by Lady... more Objective: Demonstrate the effective use of community-based evidence for health promotion by Lady Health Workers (LHWs) in Sindh, Pakistan. Methods: A baseline study on mothers and children provided local evidence for risk communication tools designed and tested by LHWs. The communities were randomized to intervention and control. LHWs visited women before and after childbirth to discuss safe practices in pregnancy, in the intervention group LHW using the new tools and in the control group using their standard procedures. A household survey and focus groups permitted assessment of the impact of the intervention. Results: Women in the intervention communities were more likely to attend prenatal checkups, to stop routine heavy work during pregnancy, to give colostrum to newborn babies, and to maintain exclusive breastfeeding for four months. Community focus groups confirmed a positive reaction to the tools. Conclusion: Discussion by lay health workers of local evidence underlying safe motherhood messages improved uptake of protective health practices. Practice implications: Door-to-door health promotion based on culturally appropriate interaction around relevant evidence can have a positive impact on health practices. Engaging health workers from the onset builds capacities, improves dialogue within the health system and performance of frontline health workers.
Journal of Interpersonal Violence, 2010
Worldwide, many women who experience domestic violence keep their experience secret. Few report t... more Worldwide, many women who experience domestic violence keep their experience secret. Few report to official bodies. In a national survey of abuse against women in Pakistan, we examined factors related to disclosure: women who had experienced physical violence telling someone about it. In focus groups, we explored why women do not report domestic violence. Nearly one third of the 23,430 women interviewed had experienced physical violence. Only 35% of them had told anyone about it, almost always someone within their own family. Several personal and family factors were associated with disclosure. Having discussed the issue and feeling empowered to discuss violence were consistent associations. Of the 7,895 women who had suffered physical violence, only 14 had reported the matter to the police. Female focus groups said women who report violence risk their reputation and bring dishonor to the family; women fear reporting violence because it may exacerbate the problem and may lead to sepa...
BMC Health Services Research, 2011
Background: In rebuilding devastated health services, the government of Afghanistan has provided ... more Background: In rebuilding devastated health services, the government of Afghanistan has provided access to basic services mainly by contracting with non-government organisations (NGOs), and more recently the Strengthening Mechanism (SM) of contracting with Provincial Health Offices. Community-based information about the public's views and experience of health services is scarce. Methods: Field teams visited households in a stratified random sample of 30 communities in two districts in Kabul province, with health services mainly provided either by an NGO or through the SM and administered a questionnaire about household views, use, and experience of health services, including payments for services and corruption. They later discussed the findings with separate community focus groups of men and women. We calculated weighted frequencies of views and experience of services and multivariate analysis examined the related factors. Results: The survey covered 3283 households including 2845 recent health service users. Some 42% of households in the SM district and 57% in the NGO district rated available health services as good. Some 63% of households in the SM district (adjacent to Kabul) and 93% in the NGO district ordinarily used government health facilities. Service users rated private facilities more positively than government facilities. Government service users were more satisfied in urban facilities, if the household head was not educated, if they had enough food in the last week, and if they waited less than 30 minutes. Many households were unwilling to comment on corruption in health services; 15% in the SM district and 26% in the NGO district reported having been asked for an unofficial payment. Despite a policy of free services, one in seven users paid for treatment in government facilities, and three in four paid for medicine outside the facilities. Focus groups confirmed people knew payments were unofficial; they were afraid to talk about corruption. Conclusions: Households used government health services but preferred private services. The experience of service users was similar in the SM and NGO districts. People made unofficial payments in government facilities, whether SM or NGO run. Tackling corruption in health services is an important part of anti-corruption measures in Afghanistan.
BMC Health Services Research, 2011
Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is par... more Background: Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy. Method: In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering. Findings: The most consistent and prominent of 28 candidate risk factors and underlying determinants for nonfatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5). Interpretation: Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their livesgenital mutilation, domestic violence, and steep power gradientsis accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.
BMC Health Services Research, 2011
Background: The government of Pakistan introduced devolution in 2001. Responsibility for delivery... more Background: The government of Pakistan introduced devolution in 2001. Responsibility for delivery of most health services passed from provincial to district governments. Two national surveys examined public opinions, use, and experience of health services in 2001 and 2004, to assess the impact of devolution on these services from the point of view of the public. Methods: A stratified random cluster sample drawn in 2001 and revisited in 2004 included households in all districts. Field teams administered a questionnaire covering views about available health services, use of government and private health services, and experience and satisfaction with the service. Focus groups in each community discussed reasons behind the findings, and district nazims (elected mayors) and administrators commented about implementation of devolution. Multivariate analysis, with an adjustment for clustering, examined changes over time, and associations with use and satisfaction with services in 2004. Results: Few of 57,321 households interviewed in 2002 were satisfied with available government health services (23%), with a similar satisfaction (27%) among 53,960 households in 2004. Less households used government health services in 2004 (24%) than in 2002 (29%); the decrease was significant in the most populous province. In 2004, households were more likely to use government services if they were satisfied with the services, poorer, or less educated. The majority of users of government health services were satisfied; the increase from 63% to 67% between 2002 and 2004 was significant in two provinces. Satisfaction in 2004 was higher among users of private services (87%) or private unqualified practitioners (78%). Users of government services who received all medicines from the facility or who were given an explanation of their condition were more likely to be satisfied. Focus groups explained that people avoid government health services particularly because of bad treatment from staff, and unavailable or poor quality medicines. District nazims and administrators cited problems with implementation of devolution, especially with transfer of funds. Conclusions: Under devolution, the public did not experience improved government health services, but devolution was not fully implemented as intended. An ongoing social audit process could provide a basis for local and national accountability of health services.
… and Training (CIET) …, 2005
Contents List of tables............................................................................. more Contents List of tables..................................................................................................................... iii List of boxes........................................................................... ... ... Services provided by the district government......................................................................67 Agriculture services ............................ ...
Background: Household decision-makers decide about service use based largely on the costs and per... more Background: Household decision-makers decide about service use based largely on the costs and perceived benefits of health interventions. Very often this leads to different decisions than those imagined by health planners, resulting in under-utilisation of public services like immunisation. In the case of Lasbela district in the south of Pakistan, only one in every ten children is immunised despite free immunisation offers by government health services. Methods/design: In 32 communities representative of Lasbela district, 3344 households participated in a baseline survey on early child health. In the 18 randomly selected intervention communities, we will stimulate discussions on the household cost-benefit equation, as measured in the baseline. The reference (control) communities will also participate in the three annual followup surveys, feedback of the general survey results and the usual health promotion activities relating to immunisation, but without focussed discussion on the household cost-benefit equations. Discussion: This project proposes knowledge translation as a two-way communication that can be augmented by local and international evidence. We will document cultural and contextual barriers to immunisation in the context of household cost-benefit equations. The project makes this information accessible to health managers, and reciprocally, makes information on immunisation effects and side effects available to communities. We will measure the impact of this two-way knowledge translation on immunisation uptake. Background Despite billions of dollars spent on childhood immunisation, some countries have never reached universal childhood immunisation (UCI), and many more have been unable to sustain it. An estimated 1.5 million deaths under 5 years of age can be prevented by vaccination each
BMC International Health and Human Rights, 2009
BACKGROUND: Rates of childhood vaccination in Pakistan remain low.There is continuing debate abou... more BACKGROUND: Rates of childhood vaccination in Pakistan remain low.There is continuing debate about the role of consumer and service factors in determining levels of vaccination in developing countries. METHODS: In a stratified random cluster sample of census enumeration areas across four districts in Pakistan, household interviews about vaccination of children and potentially related factors with 10,423 mothers of 14,542 children
BMC International Health and Human Rights, 2009
BACKGROUND: Achieving equity means increased uptake of health services for those who need it most... more BACKGROUND: Achieving equity means increased uptake of health services for those who need it most. But the poorest families continue to have the poorest service. In Pakistan, large numbers of children do not access vaccination against measles despite the national government's effort to achieve universal coverage. METHODS: A cross-sectional study of a random sample of 23 rural and 9 urban