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Search Results: 1 - 10 of 1961 matches for " Sabine Gabrysch "
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Still too far to walk: Literature review of the determinants of delivery service use
Sabine Gabrysch, Oona MR Campbell
BMC Pregnancy and Childbirth , 2009, DOI: 10.1186/1471-2393-9-34
Abstract: We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility.There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables.Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality.Every year, more than 500,000 maternal deaths occur worldwide, 4 million newborns die and another 3 million babies are stillborn [1-3]. Nearly all these deaths take place in low- and middle-income countries and most could be prevented with current medical care [1,4].Most obstetric complications occur around the time of delivery and cann
The Influence of Distance and Level of Care on Delivery Place in Rural Zambia: A Study of Linked National Data in a Geographic Information System
Sabine Gabrysch ,Simon Cousens,Jonathan Cox,Oona M. R. Campbell
PLOS Medicine , 2011, DOI: 10.1371/journal.pmed.1000394
Abstract: Background Maternal and perinatal mortality could be reduced if all women delivered in settings where skilled attendants could provide emergency obstetric care (EmOC) if complications arise. Research on determinants of skilled attendance at delivery has focussed on household and individual factors, neglecting the influence of the health service environment, in part due to a lack of suitable data. The aim of this study was to quantify the effects of distance to care and level of care on women's use of health facilities for delivery in rural Zambia, and to compare their population impact to that of other important determinants. Methods and Findings Using a geographic information system (GIS), we linked national household data from the Zambian Demographic and Health Survey 2007 with national facility data from the Zambian Health Facility Census 2005 and calculated straight-line distances. Health facilities were classified by whether they provided comprehensive EmOC (CEmOC), basic EmOC (BEmOC), or limited or substandard services. Multivariable multilevel logistic regression analyses were performed to investigate the influence of distance to care and level of care on place of delivery (facility or home) for 3,682 rural births, controlling for a wide range of confounders. Only a third of rural Zambian births occurred at a health facility, and half of all births were to mothers living more than 25 km from a facility of BEmOC standard or better. As distance to the closest health facility doubled, the odds of facility delivery decreased by 29% (95% CI, 14%–40%). Independently, each step increase in level of care led to 26% higher odds of facility delivery (95% CI, 7%–48%). The population impact of poor geographic access to EmOC was at least of similar magnitude as that of low maternal education, household poverty, or lack of female autonomy. Conclusions Lack of geographic access to emergency obstetric care is a key factor explaining why most rural deliveries in Zambia still occur at home without skilled care. Addressing geographic and quality barriers is crucial to increase service use and to lower maternal and perinatal mortality. Linking datasets using GIS has great potential for future research and can help overcome the neglect of health system factors in research and policy. Please see later in the article for the Editors' Summary
The Influence of Distance and Level of Service Provision on Antenatal Care Use in Rural Zambia
Nicholas N. A. Kyei, Oona M. R. Campbell, Sabine Gabrysch
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046475
Abstract: Background Antenatal care (ANC) presents important opportunities to reach women with crucial interventions. Studies on determinants of ANC use often focus on household and individual factors; few investigate the role of health service factors, partly due to lack of appropriate data. We assessed how distance to facilities and level of service provision at ANC facilities in Zambia influenced the number and timing of ANC visits and the quality of care received. Methods and Findings Using the 2005 Zambian national Health Facility Census, we classified ANC facilities according to the level of service provision. In a geographic information system, we linked the facility information to household data from the 2007 DHS to calculate straight-line distances. We performed multivariable multilevel logistic regression on 2405 rural births to investigate the influence of distance to care and of level of provision on three aspects of ANC use: attendance of at least four visits, visit in first trimester and receipt of quality ANC (4+ visits with skilled health worker and 8+ interventions). We found no effect of distance on timing of ANC or number of visits, and better level of provision at the closest facility was not associated with either earlier ANC attendance or higher number of visits. However, there was a strong influence of both distance to a facility, and level of provision at the closest ANC facility on the quality of ANC received; for each 10 km increase in distance, the odds of women receiving good quality ANC decreased by a quarter, while each increase in the level of provision category of the closest facility was associated with a 54% increase in the odds of receiving good quality ANC. Conclusions To improve ANC quality received by mothers, efforts should focus on improving the level of services provided at ANC facilities and their accessibility.
Quality of antenatal care in Zambia: a national assessment
Nicholas N A Kyei, Collins Chansa, Sabine Gabrysch
BMC Pregnancy and Childbirth , 2012, DOI: 10.1186/1471-2393-12-151
Abstract: We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007.We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester.DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress.Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth [1]. In 2008 over 300,000 maternal deaths occurred worldwide and almost all of these in low- and middle-income countries [2,3]. It is also estimated that every year 3 million newborn babies die within the first month of life [4] and between 2.1 to 3.8 million babies are stillborn [5-7]. Antenatal care (ANC) is one of the recommended interventions to help reduce these alarming maternal and newborn mortalities [8-10]. Most low-income countries have adopted a focused ANC strategy promoted by WHO which includes four visits and structured elements within these [11-14].Although the percentage of women attending ANC (for at least one visit) generally tends to be satisfa
Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia
Terhi J. Lohela, Oona M. R. Campbell, Sabine Gabrysch
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0052110
Abstract: Background Globally, approximately 3 million babies die annually within their first month. Access to adequate care at birth is needed to reduce newborn as well as maternal deaths. We explore the influence of distance to delivery care and of level of care on early neonatal mortality in rural Zambia and Malawi, the influence of distance (and level of care) on facility delivery, and the influence of facility delivery on early neonatal mortality. Methods and Findings National Health Facility Censuses were used to classify the level of obstetric care for 1131 Zambian and 446 Malawian delivery facilities. Straight-line distances to facilities were calculated for 3771 newborns in the 2007 Zambia DHS and 8842 newborns in the 2004 Malawi DHS. There was no association between distance to care and early neonatal mortality in Malawi (OR 0.97, 95%CI 0.58–1.60), while in Zambia, further distance (per 10 km) was associated with lower mortality (OR 0.55, 95%CI 0.35–0.87). The level of care provided in the closest facility showed no association with early neonatal mortality in either Malawi (OR 1.02, 95%CI 0.90–1.16) or Zambia (OR 1.02, 95%CI 0.82–1.26). In both countries, distance to care was strongly associated with facility use for delivery (Malawi: OR 0.35 per 10km, 95%CI 0.26–0.46). All results are adjusted for available confounders. Early neonatal mortality did not differ by frequency of facility delivery in the community. Conclusions While better geographic access and higher level of care were associated with more frequent facility delivery, there was no association with lower early neonatal mortality. This could be due to low quality of care for newborns at health facilities, but differential underreporting of early neonatal deaths in the DHS is an alternative explanation. Improved data sources are needed to monitor progress in the provision of obstetric and newborn care and its impact on mortality.
New Signal Functions to Measure the Ability of Health Facilities to Provide Routine and Emergency Newborn Care
Sabine Gabrysch ,Giulia Civitelli,Karen M. Edmond,Matthews Mathai,Moazzam Ali,Zulfiqar A. Bhutta,Oona M. R. Campbell
PLOS Medicine , 2012, DOI: 10.1371/journal.pmed.1001340
Abstract:
Cultural adaptation of birthing services in rural Ayacucho, Peru
Gabrysch,Sabine; Lema,Claudia; Bedri?ana,Eduardo; Bautista,Marco A; Malca,Rosa; Campbell,Oona MR; Miranda,J Jaime;
Bulletin of the World Health Organization , 2009, DOI: 10.1590/S0042-96862009000900018
Abstract: problem: maternal mortality is particularly high among poor, indigenous women in rural peru, and the use of facility care is low, partly due to cultural insensitivities of the health care system. approach: a culturally appropriate delivery care model was developed in poor and isolated rural communities, and implemented between 1999 and 2001 in cooperation with the quechua indigenous communities and health professionals. data on birth location and attendance in one health centre have been collected up to 2007. local setting: the international nongovernmental organization, health unlimited, and its peruvian partner organization, salud sín límites perú, conducted the project in santillana district in ayacucho. relevant changes: the model involves features such as a rope and bench for vertical delivery position, inclusion of family and traditional birth attendants in the delivery process and use of the quechua language. the proportion of births delivered in the health facility increased from 6% in 1999 to 83% in 2007 with high satisfaction levels. lessons learned: implementing a model of skilled delivery attendance that integrates modern medical and traditional andean elements is feasible and sustainable. indigenous women with little formal education do use delivery services if their needs are met. this contradicts common victim-blaming attitudes that ascribe high levels of home births to "cultural preferences" or "ignorance".
Quality along the Continuum: A Health Facility Assessment of Intrapartum and Postnatal Care in Ghana
Robin C. Nesbitt, Terhi J. Lohela, Alexander Manu, Linda Vesel, Eunice Okyere, Karen Edmond, Seth Owusu-Agyei, Betty R. Kirkwood, Sabine Gabrysch
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081089
Abstract: Objective To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate “effective coverage” of skilled attendance in Brong Ahafo, Ghana. Methods We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC), emergency newborn care (EmNC) and non-medical quality. Linking the health facility assessment to surveillance data we estimated “effective coverage” of skilled attendance as the proportion of births in facilities of high quality. Findings Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as “low” or “substandard” for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was “low” or “substandard” in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with “high” or “highest” quality in all dimensions. Conclusion Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated “effective coverage” of skilled attendance at 18%, thus revealing a large “quality gap.” Effective coverage could be a meaningful indicator of progress towards reducing maternal and newborn mortality.
Silicon Oxide Passivation of Single-Crystalline CVD Diamond Evaluated by the Time-of-Flight Technique
Kiran Kumar Kovi,Saman Majdi,Markus Gabrysch,Jan Isberg
Physics , 2014, DOI: 10.1149/2.004405ssl
Abstract: The excellent material properties of diamond make it highly desirable for many extreme electronic applications that are out of reach of conventional electronic materials. For commercial diamond devices to become a reality, it is necessary to have an effective surface passivation since the passivation determines the ability of the device to withstand high surface electric fields. In this paper we present data from lateral Time-of-Flight studies on SiO2-passivated intrinsic single-crystalline CVD diamond. The SiO2 films were deposited using three different techniques. The influence of the passivation on hole transport was studied, which resulted in the increase of hole mobilities. The results from the three different passivations are compared.
Identifying Where the Values Come from IT-Innovations in Health and Social Care  [PDF]
Vivian Vimarlund, Sabine Koch
Intelligent Information Management (IIM) , 2012, DOI: 10.4236/iim.2012.425042
Abstract: Studies aimed to capture the effects of IT-innovations in health and social care have shown that there is a gap between expected and factual outcomes. Many decision makers feel the need to articulate an ideal end-state for their organiza-tions. Striking the balance between novelty and believability of such an ideal end-state is often tricky and they become neither satisfied with the ideal not the visioning. In this study, we explore the contribution of IT-innovations to health and social care. The results showed that coherence between context and IT-innovation is important to capture effects and outcomes. Being coherent rather than visionary contributes to identify where you are, as an organization, and to capture effects and outcomes that “make sense” in the context in question. The paper makes an exposition from the model building, algorithm design to performance analysis and contributes to the academic prosperity in Intelligent In-formation Management The knowledge generated is expected to provide input when identifying goals that IT-investments are supposed to achieve.
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