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Epoché and objectivity in Phenomenological meaning-making in Educational Research

2021-01-04T00:00:00Z

de Bruin, L 2021-01-04 Epoché and objectivity in Phenomenological meaning-making in Educational Research Epoché within phenomenology sets aside or suspends assumptions and resistance to prejudices that rest on the principal that humans bring schemas and frameworks into being. This stance of analysis and multi-layered process reveals phenomenologically lived experiences and ‘being in the world’ that as essences shape forms of reflective thought and understanding on phenomena. In this chapter, the notion of epoché, or bracketing as an essential attitude to phenomenological reasoning, is surveyed through leading thinkers spanning the field of phenomenology. Epoché as an essential attitude to transcendental, hermeneutic and existential phenomenological reasoning, and argumentation between essence and existence, as well as more recent ‘bridling’ and ‘sidling’ approaches are considered. This chapter informs researchers, especially those recent to phenomenological investigation, of the implications of such theories and techniques, their evolution in the minds of developing researcher minds, and the complexity and delicacy with which all researchers are compelled to approach this fascinating aspect of qualitative understanding and meaning making. Chapter

Instrumental Music Educators in a COVID Landscape: A Reassertion of Relationality and Connection in Teaching Practice

2021-01-08T00:00:00Z

de Bruin, LR 2021-01-08 Instrumental Music Educators in a COVID Landscape: A Reassertion of Relationality and Connection in Teaching Practice For many countries instrumental music tuition in secondary schools is a ubiquitous event that provides situated and personalized instruction in the learning of an instrument. Opportunities and methods through which teachers operate during the COVID-19 outbreak challenged music educators as to how they taught, engaged, and interacted with students across online platforms, with alarm over aerosol dispersement a major factor in maintaining online instrumental music tuition even as students returned to “normal” face to face classes. This qualitative study investigated the practices employed by instrumental music educators in secondary schools in Melbourne, Australia, analyzing teacher perspectives to music tuition amidst the restriction of interaction with students remotely via online means. Thematic analysis of the interview transcripts revealed music educational approaches that fostered connection, empathy and receptiveness to relationship-building, guiding students in slower and deeper learner-centered approaches, asserting pedagogical practices that reinforced and promoted interpersonal connectedness in and through musical experience and discovery. These findings provide a framework for how music educators can facilitate connection, motivation and student autonomy generating personal meaning and commitment to music making and the learning relationship, which can translate to significant student learning and value in the learning music. Exploring teachers’ pedagogical practices and behaviors within this dyadic teacher-student relationship is a significant addition to the literature, enabling the consideration of the type of connective behaviors required to stimulate and develop long-term interest in music. Journal Article

COVID-19 Community Response Strategy in Local Governments: Lessons and Considerations for Planning

2020-12-20T00:00:00Z

Recio, R; Ordonez, M; Berse, K; Torneo, A; Rayo, A; Borja, AL; Andres, AA; Nazareno, R; Soriano, CR; Salvosa II, F 2020-12-20 COVID-19 Community Response Strategy in Local Governments: Lessons and Considerations for Planning In the Philippines, local governments are at the frontline of addressing the COVID-19 pandemic. While the national government has focused on building the capacities of the health system, mobilising national resources, and issuing policies, interpreting and implementing actual measures have been largely left at the hands of local government units. This chapter outlines key policy considerations for local government units (LGUs) - provinces, cities and municipalities – as they revisit their Covid-19 Community Response Strategy and draw up post-pandemic recovery plans. Chapter

Prevalence and factors associated with antenatal care service access among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study.

2020-01-01T00:00:00Z

Akter, S; Rich, JL; Davies, K; Inder, KJ 2020 Prevalence and factors associated with antenatal care service access among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study. BACKGROUND: Prevalence of accessing antenatal care (ANC) services among Indigenous women in the Chittagong Hill Tracts (CHT) is unknown. This study aims to estimate the prevalence of accessing ANC services by Indigenous women in the CHT and identify factors associated with knowledge of, and attendance at, ANC services. METHODS: Using a cross-sectional design three Indigenous groups in Khagrachari district, CHT, Bangladesh were surveyed between September 2017 and February 2018. Indigenous women within 36 months of delivery were asked about attending ANC services and the number who attended was used to estimate prevalence. Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village; results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI). RESULTS: Of 494 indigenous women who met the inclusion criteria in two upazilas, 438 participated (89% response rate) in the study, 75% were aged 16-29 years. Sixty-nine percent were aware of ANC services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48-0.58). Half (52%; n = 121) attended private facilities. Independent factors associated with knowledge about ANC were age ≥30 years (OR 2.2, 95%CI 1.1-4.6), monthly household income greater than 20,000 Bangladeshi Taka (OR 3.4, 95%CI 1.4-8.6); knowledge of pregnancy-related complications (OR 3.6, 95%CI 1.6-8.1), knowledge about nearest health facilities (OR 4.3, 95%CI 2.1-8.8); and attending secondary school or above (OR 4.8, 95%CI 2.1-11). Independent factors associated with attending ANC services were having prior knowledge of ANC benefits (OR 7.7, 95%CI 3.6-16), Indigenous women residing in Khagrachhari Sadar subdistrict (OR 6.5, 95%CI 1.7-25); and monthly household income of 20,000 Bangladeshi Taka or above (OR 2.8, 95%CI 1.1-7.4). CONCLUSION: Approximately half of Indigenous women from Chittagong Hill Tracts Bangladesh attended ANC services at least once. Better awareness and education may improve ANC attendance for Indigenous women. Cultural factors influencing attendance need to be explored. Journal Article

Toward identifying the critical mass in spatial two-sided markets

2020-11-01T00:00:00Z

Navidi, Z; Nagel, K; Winter, S 2020-11-01 Toward identifying the critical mass in spatial two-sided markets Unlike their nonspatial counterparts, spatial multi-sided platforms are matchmaking platforms with an additional layer of complexity: their customers expect to meet in space, not only virtually. This additional challenge will be studied in this paper in the context of a two-sided ride-sharing platform, which serves drivers and passengers. As with any two-sided platform, there is an interdependence between both groups of customers: More drivers are more attractive for passengers, and vice versa. This interdependence creates the old chicken-and-egg problem, only that here drivers and passengers need to be matched not for a virtual transaction, but by their ability to meet physically and travel jointly. We argue, and illustrate by simulations, that in spatial multi-sided markets there is not a single critical mass frontier that needs to be reached in order to make the system self-sustained (as in nonspatial markets), and that this frontier is varying from one location to the next, depending on the density and distribution of the demand and supply over space and time. Identification of the critical mass frontier will allow for better evaluation of implementation policies and regulations. Journal Article

Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh.

2020-12-23T00:00:00Z

Akter, S; Davies, K; Rich, JL; Inder, KJ 2020-12-23 Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh. OBJECTIVES: Bangladesh has achieved notable success in improving maternal health by increasing women's access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities' perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities' perspectives on challenges and opportunities for improving MHC service access in the CHT. DESIGN: This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. RESULTS: Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. CONCLUSION: Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential. Journal Article

Perceptions and experiences of the prevention, identification and management of postpartum haemorrhage: a qualitative evidence synthesis

Akter, S; Lorencatto, F; Forbes, G; Miller, S; Althabe, F; Coomarasamy, A; Gallos, ID; Oladapo, OT; Vogel, JP; Thomas, E; Bohren, MA Perceptions and experiences of the prevention, identification and management of postpartum haemorrhage: a qualitative evidence synthesis Journal Article

Transforming intrapartum care: Respectful maternity care

2020-08-01T00:00:00Z

Bohren, MA; Tuncalp, O; Miller, S 2020-08-01 Transforming intrapartum care: Respectful maternity care Respectful maternity care is recommended by the World Health Organization and refers to care that maintains dignity, privacy, confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth. In this paper, we review the evidence of respectful maternity care and discuss considerations for professional practice for health care providers. While there is limited evidence on what type of interventions can improve respectful maternity care, promising skills development for providers has included training on values, transforming attitudes, and interpersonal communication. Within a health facility, enabling environments may be created by setting up quality improvement teams, monitoring experiences of poor treatment, mentorship, and improved working conditions for staff. In order to provide respectful care, health facilities and health systems must be structured in a way that supports and respects providers, and ensures adequate infrastructure and organisation of the maternity ward. Journal Article

How Women Are Treated During Facility-Based Childbirth in Four Countries: A Cross-sectional Study With Labour Observations and Community-Based Surveys

2020-04-01T00:00:00Z

Bohren, MA; Mehrtash, H; Fawole, B; Maung, TM; Balde, MD; Maya, E; Thwin, SS; Aderoba, AK; Vogel, JP; Irinyenikan, TA; Adeyanju, AO; Mon, NO; Adu-Bonsaffoh, K; Landoulsi, S; Guure, C; Adanu, R; Diallo, BA; Gulmezoglu, AM; Soumah, A-M; Sall, AO; Tuncalp, O 2020-04-01 How Women Are Treated During Facility-Based Childbirth in Four Countries: A Cross-sectional Study With Labour Observations and Community-Based Surveys Journal Article

Mistreatment during childbirth reply

2020-09-19T00:00:00Z

Bohren, MA; Adu-Bonsaffoh, K; Irinyenikan, TA; Maung, TM; Balde, MD; Tuncalp, O 2020-09-19 Mistreatment during childbirth reply Journal Article

Labour companionship and women's experiences of mistreatment during childbirth: results from a multi-country community-based survey

2020-01-01T00:00:00Z

Balde, MD; Nasiri, K; Mehrtash, H; Soumah, A-M; Bohren, MA; Diallo, BA; Irinyenikan, TA; Maung, TM; Thwin, SS; Aderoba, AK; Vogel, JP; Mon, NO; Adu-Bonsaffoh, K; Tuncalp, O 2020-01-01 Labour companionship and women's experiences of mistreatment during childbirth: results from a multi-country community-based survey BACKGROUND: Evidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool. METHODS: We conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment. RESULTS: Of 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9-6.9) and non-consented vaginal examinations (AOR 3.2, 1.6-6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7-3.1) and poor communication (AOR 2.0, 1.3-3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3-0.9). CONCLUSION: Labour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women's choices and autonomy. Journal Article

Work and breast milk feeding: a qualitative exploration of the experience of lactating mothers working in ready made garments factories in urban Bangladesh

2020-12-01T00:00:00Z

Hasan, AMR; Smith, G; Selim, MA; Akter, S; Khan, NUZ; Sharmin, T; Rasheed, S 2020-12 Work and breast milk feeding: a qualitative exploration of the experience of lactating mothers working in ready made garments factories in urban Bangladesh Abstract Background In Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive breastfeeding. As Ready Made Garment (RMG) factories have been the largest employer of low income women in Bangladesh, the objective of our study was to explore the barriers and facilitators of breastfeeding and perceptions about use of expressed breast milk among mothers who worked in the RMG sector. Methods This formative research was conducted during July–September 2015 in two slums of Dhaka among RMG workers who were mothers and the caregivers of 0–12 month old infants. Qualitative data was obtained from purposively selected participants of 8 in-depth interviews and 4 focus group discussions (mothers and caregivers), and 2 key informant (RMG factory official) interviews. Mothers were from multiple RMG factories while factory officials were from a single factory. Thematic analysis was conducted. Results The main themes of qualitative exploration were knowledge and experience of breastfeeding; structural barriers (home and workplace); consequences of inadequate breastfeeding; and perception and experience of using expressed breast milk. Despite knowledge both of the benefits of breast milk and of the importance of breastfeeding for 6 months, most mothers introduced formula as early as 2 months to prepare for their return to work. Barriers such as excessive workload, inadequate crèche facilities at work, and lack of adequate caregivers at home impeded exclusive breastfeeding. Mothers and caregivers had very little knowledge about the use of expressed breast milk and were concerned about contamination. Conclusion As RMG factories are the largest employer of low-income women in Bangladesh, facilitating RMG factory working mothers’ ability to use breast milk could help to promote infant health and help women remain in the workforce. Journal Article

The first 2 h after birth: prevalence and factors associated with neonatal care practices from a multicountry, facility-based, observational study.

2021-01-01T00:00:00Z

Sacks, E; Mehrtash, H; Bohren, M; Balde, MD; Vogel, JP; Adu-Bonsaffoh, K; Portela, A; Aderoba, AK; Irinyenikan, TA; Maung, TM; Thwin, SS; Mon, NO; Soumah, A-M; Guure, C; Diallo, BA; Adeyanju, AO; Maya, E; Adanu, R; Gülmezoglu, AM; Tunçalp, Ö 2021-01 The first 2 h after birth: prevalence and factors associated with neonatal care practices from a multicountry, facility-based, observational study. BACKGROUND: Amid efforts to improve the quality of care for women and neonates during childbirth, there is growing interest in the experience of care, including respectful care practices. However, there is little research on the prevalence of practices that might constitute mistreatment of neonates. This study aims to describe the care received by neonates up to 2 h after birth in a sample of three countries in west Africa. METHODS: Data from this multicountry, facility-based, observational study were collected on 15 neonatal care practices across nine facilities in Ghana, Guinea, and Nigeria, as part of WHO's wider multicountry study on how women are treated during childbirth. Women were eligible if they were admitted to the participating health facilities for childbirth, in early established labour or active labour, aged 15 years or older, and provided written informed consent on behalf of themselves and their neonate. All labour observations were continuous, one-to-one observations of women and neonates by independent data collectors. Descriptive statistics and multivariate logistic regressions were used to examine associations between these neonatal care practices, maternal and neonate characteristics, and maternal mistreatment. Early neonate deaths, stillbirths, and higher order multiple births were excluded from analysis. FINDINGS: Data collection took place from Sept 19, 2016, to Feb 26, 2017, in Nigeria; from Aug 1, 2017, to Jan 18, 2018, in Ghana; and from July 1 to Oct 30, 2017, in Guinea. We included data for 362 women-neonate dyads (356 [98%] with available data for neonatal care practices) in Nigeria, 760 (749 [99%]) in Ghana, and 558 (522 [94%]) in Guinea. Delayed cord clamping was done for most neonates (1493 [91·8%] of 1627); other practices, such as skin-to-skin contact, were less commonly done (1048 [64·4%]). During the first 2 h after birth, separation of the mother and neonate occurred in 844 (51·9%) of 1627 cases; and was more common for mothers who were single (adjusted odds ratio [AOR; adjusting for country, maternal age, education, marital status, neonate weight at birth, and neonate sex] 1·8, 95% CI 1·3-2·6) than those who were married or cohabiting. Lack of maternal education was associated with increased likelihood of neonates not receiving recommended breastfeeding practices. Neonates with a low birthweight (<2·5 kg) were more likely (1·7, 1·1-2·8) to not begin breastfeeding on demand than full weight neonates. When women experienced physical abuse from providers within 1 h before childbirth, their neonates were more likely to be slapped (AOR 1·9, 1·1-3·9). INTERPRETATION: A high proportion of neonates did not receive recommended care practices, and some received practices that might constitute mistreatment. Further research is needed on understanding and measuring mistreatment to improve care, including respectful care, for mothers and neonates. FUNDING: US Agency for International Development, and the UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO. Journal Article

Women's experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis

2020-01-01T00:00:00Z

Tarzia, L; Bohren, MA; Cameron, J; Garcia-Moreno, C; O'Doherty, L; Fiolet, R; Hooker, L; Wellington, M; Parker, R; Koziol-McLain, J; Feder, G; Hegarty, K 2020-01-01 Women's experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis OBJECTIVE: To identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP). METHODS: The databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women's experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis. RESULTS: Thirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women's experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women. CONCLUSIONS: Our findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored. Journal Article

Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care.

2020-12-01T00:00:00Z

Asefa, A; McPake, B; Langer, A; Bohren, MA; Morgan, A 2020-12 Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care. Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system "hardware" and "software" factors influencing the promotion of RMC were identified, and their interaction was complex. The "hardware" factors included bed availability, infrastructure and supplies, financing, and health workforce. "Software" factors encompassed service providers' mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC. Journal Article

Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017.

2020-12-01T00:00:00Z

Zahroh, RI; Disney, G; Betrán, AP; Bohren, MA 2020-12 Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017. INTRODUCTION: Caesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This study aimed to investigate trends of CS use and inequalities across sociodemographic characteristics in Indonesia over a 30-year period. METHODS: Seven waves of the Indonesia Demographic and Health Survey were used to estimate trends and inequalities in CS from 1987 to 2017. Relative and absolute inequalities across a range of sociodemographic characteristics were estimated and trends in inequalities were assessed through changes in rate ratio and rate difference. RESULTS: The proportion of facility-based births in Indonesia has increased in the past 30 years, coinciding with an increase in CS rate (CSR) (1991 CSR: 1.6% (95% CI 1.3 to 1.9); 2017 CSR: 17.6% (95% CI 16.7 to 18.5)). Higher rates of CS are observed mostly in Western Indonesia, while lower CSRs are observed in Eastern Indonesia. Inequalities of CSRs in Indonesia are observed across type of health facility (public/private), regions, places of residence, wealth quintiles and maternal education, with the highest CSRs in more affluent and educated groups. Widening absolute inequalities of CS are observed across all sociodemographic characteristics, except facility type, where CSR gaps between public and private facilities have closed on both relative and absolute scales. CONCLUSION: This study provides evidence of increasing trends in CSRs and widening absolute inequalities in CSRs across different sociodemographic groups of women in Indonesia. The context of increasing CSRs across society, however, may have resulted in more stable relative inequalities. Improving understanding of the drivers of these trends in Indonesia and, particularly, of women's and providers' perspectives and preferences for childbirth, should be prioritised to optimise the use of CS. Journal Article

Women's experiences of mistreatment during childbirth and their satisfaction with care: findings from a multicountry community-based study in four countries.

2021-01-01T00:00:00Z

Maung, TM; Mon, NO; Mehrtash, H; Bonsaffoh, KA; Vogel, JP; Aderoba, AK; Irinyenikan, TA; Balde, MD; Pattanittum, P; Tuncalp, Ö; Bohren, MA 2021-01 Women's experiences of mistreatment during childbirth and their satisfaction with care: findings from a multicountry community-based study in four countries. INTRODUCTION: Experiences of care and satisfaction are intrinsically linked, as user's experiences of care may directly impact satisfaction, or indirectly impact user's expectations and values. Both experiences of care and satisfaction are important to measure so that quality can be monitored and improved. Globally, women experience mistreatment during childbirth at facilities; however, there is limited evidence exploring the mistreatment and women's satisfaction with care during childbirth. METHODS: This is a secondary analysis of a cross-sectional survey within the WHO study 'How women are treated during facility-based childbirth' exploring the mistreatment of women during childbirth in Ghana, Guinea, Myanmar and Nigeria. Women's experiences of mistreatment and satisfaction with care during childbirth was explored. Multivariable logistic regression modelling was conducted to evaluate the association between mistreatment, women's overall satisfaction with the care they received, and whether they would recommend the facility to others. RESULTS: 2672 women were included in this analysis. Despite over one-third of women reporting experience of mistreatment (35.4%), overall satisfaction for services received and recommendation of the facility to others was high, 88.4% and 90%, respectively. Women who reported experiences of mistreatment were more likely to report lower satisfaction with care: women were more likely to be satisfied if they did not experience verbal abuse (adjusted OR (AOR) 4.52, 95% CI 3.50 to 5.85), or had short waiting times (AOR 5.12, 95% CI 3.94 to 6.65). Women who did not experience any physical or verbal abuse or discrimination were more likely to recommend the facility to others (AOR 3.89, 95% CI 2.98 to 5.06). CONCLUSION: Measuring both women's experiences and their satisfaction with care are critical to assess quality and provide actionable evidence for quality improvement. These measures can enable health systems to identify and respond to root causes contributing to measures of satisfaction. Journal Article

Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in Iran: a mixed-methods systematic review.

2021-01-02T00:00:00Z

Shirzad, M; Shakibazadeh, E; Hajimiri, K; Betran, AP; Jahanfar, S; Bohren, MA; Opiyo, N; Long, Q; Kingdon, C; Colomar, M; Abedini, M 2021-01-02 Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in Iran: a mixed-methods systematic review. BACKGROUND: Cesarean section (CS) rates have been increasing globally. Iran has one of the highest CS rates in the world (47.9%). This review was conducted to assess the prevalence of and reasons for women's, family members', and health professionals' preferences for CS in Iran. METHODS AND FINDINGS: In this mixed-methods systematic review, we searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, Google scholar; as well as Iranian scientific databases including SID, and Magiran from 1 January 1990 to 8th October 2019. Primary quantitative, qualitative, and mixed-methods studies that had been conducted in Iran with Persian or English languages were included. Meta-analysis of quantitative studies was conducted by extracting data from 65 cross-sectional, longitudinal, and baseline measurements of interventional studies. For meta-synthesis, we used 26 qualitative studies with designs such as ethnography, phenomenology, case studies, and grounded theory. The Review Manager Version 5.3 and the Comprehensive Meta-Analysis (CMA) software were used for meta-analysis and meta-regression analysis. Results showed that 5.46% of nulliparous women (95% CI 5.38-5.50%; χ2 = 1117.39; df = 28 [p < 0.00001]; I2 = 97%) preferred a CS mode of delivery. Results of subgroup analysis based on the time of pregnancy showed that proportions of preference for CS reported by women were 5.94% (95% CI 5.86-5.99%) in early and middle pregnancy, and 3.81% (95% CI 3.74-3.83%), in late pregnancy. The heterogeneity was high in this review. Most women were pregnant, regardless of their parity; the risk level of participants were unknown, and some Persian publications were appraised as low in quality. A combined inductive and deductive approach was used to synthesis the qualitative data, and CERQual was used to assess confidence in the findings. Meta-synthesis generated 10 emerging themes and three final themes: 'Women's factors', 'Health professional factors', andex 'Health organization, facility, or system factors'. CONCLUSION: Despite low preference for CS among women, CS rates are still so high. This implies the role of factors beyond the individual will. We identified a multiple individual, health facility, and health system factors which affected the preference for CS in Iran. Numerous attempts were made in recent years to design, test and implement interventions to decrease unnecessary CS in Iran, such as mother-friendly hospitals, standard protocols for labor and birth, preparation classes for women, midwives, and gynaecologists, and workshops for specialists and midwives through the "health sector evolution policy". Although these programs were effective, high rates of CS persist and more efforts are needed to optimize the use of CS. Journal Article

Prevalence and factors associated with knowledge and access to delivery services at primary health care facilities amongst indigenous women in Khagrachhari district Bangladesh - A cross-sectional study

2020-11-01T00:00:00Z

Akter, S; Rich, JL; Davies, K; Inder, KJ 2020-11-01 Prevalence and factors associated with knowledge and access to delivery services at primary health care facilities amongst indigenous women in Khagrachhari district Bangladesh - A cross-sectional study OBJECTIVE: To estimate the prevalence of facility delivery knowledge and access during childbirth amongst Indigenous women in the Chittagong Hill Tracts, Bangladesh and to identify factors associated with facility delivery service utilisation. DESIGN: A cross-sectional study design using a structured self-report survey. SETTING: Two Upazilas (subdistricts) of Kharachhari hill district of the Chittagong Hill Tracts. PARTICIPANTS: Indigenous women of reproductive age (15-49 years) within 36 months of delivery. MEASUREMENTS AND FINDINGS: A modified national survey about accessing maternal health services, including delivery services was administered to all Indigenous women that met eligibility, guided by community leaders. Data collected included socio-demographic characteristics and reproductive history. Main outcome variables were the proportion of women having prior knowledge about and access to facility delivery services for childbirth in the three years prior to the survey. Secondary outcomes were sources of information about facility delivery services, decision making about delivery place, and factors associated with knowledge and attendance at facility delivery services. Factors associated with knowledge and attendance were estimated using logistic regression with results reported as adjusted odds ratios and 95% confidence intervals. With an 89% response rate, a total of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) participated in the survey, and 75% were aged 16-29 years. Relatives played a vital role as a source of information about delivery services (59%). Nearly three-quarters (73%) were aware of facility delivery services, however, prevalence of accessing delivery services was 33% (n = 143; 95% CI 0.28-0.37). Relatives were the key decision-makers for accessing facility delivery services (60%). Independent factors associated with knowledge about facility delivery were higher household income (AOR 5.3, 95%CI 2.2-13); having knowledge of nearest health care facilities (AOR 5.8, 95%CI 3.0-11); and attending antenatal care visits during last pregnancy (four or more AOR 3.1, 95% CI 1.3-7.2 and one to three visits AOR 2.7, 95% CI 1.5-5.0). Independent factors associated with accessing facility delivery services at childbirth were attending antenatal care visit; having access to media; higher level of education of partners; and residing at Khagrachhari Sadar compared to Matiranga subdistrict. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Indigenous women in Chittagong Hill Tracts, Bangladesh have sub-optimal knowledge of, and attendance at, facility delivery services for childbirth. Maternal health related interventions should target Indigenous women in order to educate and motivate them to access facility delivery services at childbirth. Rigorous research is needed to explore Indigenous cultural practices related to childbirth that might influence their access to facility delivery services. Journal Article

Effectiveness of interventions to improve rates of intravenous thrombolysis using behaviour change wheel functions: a systematic review and meta-analysis

2020-12-01T00:00:00Z

Hasnain, MG; Attia, JR; Akter, S; Rahman, T; Hall, A; Hubbard, IJ; Levi, CR; Paul, CL 2020-12 Effectiveness of interventions to improve rates of intravenous thrombolysis using behaviour change wheel functions: a systematic review and meta-analysis Abstract Background Despite being one of the few evidence-based treatments for acute ischemic stroke, intravenous thrombolysis has low implementation rates—mainly due to a narrow therapeutic window and the health system changes required to deliver it within the recommended time. This systematic review and meta-analyses explores the differential effectiveness of intervention strategies aimed at improving the rates of intravenous thrombolysis based on the number and type of behaviour change wheel functions employed. Method The following databases were searched: MEDLINE, EMBASE, PsycINFO, CINAHL and SCOPUS. Multiple authors independently completed study selection and extraction of data. The review included studies that investigated the effects of intervention strategies aimed at improving the rates of intravenous thrombolysis and/or onset-to-needle, onset-to-door and door-to-needle time for thrombolysis in patients with acute ischemic stroke. Interventions were coded according to the behaviour change wheel nomenclature. Study quality was assessed using the QualSyst scoring system for quantitative research methodologies. Random effects meta-analyses were used to examine effectiveness of interventions based on the behaviour change wheel model in improving rates of thrombolysis, while meta-regression was used to examine the association between the number of behaviour change wheel intervention strategies and intervention effectiveness. Results Results from 77 studies were included. Five behaviour change wheel interventions, ‘Education’, ‘Persuasion’, ‘Training’, ‘Environmental restructuring’ and ‘Enablement’, were found to be employed among the included studies. Effects were similar across all intervention approaches regardless of type or number of behaviour change wheel-based strategies employed. High heterogeneity (I2 > 75%) was observed for all the pooled analyses. Publication bias was also identified. Conclusion There was no evidence for preferring one type of behaviour change intervention strategy, nor for including multiple strategies in improving thrombolysis rates. However, the study results should be interpreted with caution, as they display high heterogeneity and publication bias. Journal Article

Determinants of exclusive breastfeeding practice in Bangladesh: Evidence from nationally representative survey data

2020-07-15T00:00:00Z

Rahman, MA; Khan, MN; Akter, S; Rahman, A 2020-07-15 Determinants of exclusive breastfeeding practice in Bangladesh: Evidence from nationally representative survey data Journal Article

The opportunity of membrane technology for hydrogen purification in the power to hydrogen (P2H) roadmap: a review.

2021-01-01T00:00:00Z

Lu, HT; Li, W; Miandoab, ES; Kanehashi, S; Hu, G 2021-01-01 The opportunity of membrane technology for hydrogen purification in the power to hydrogen (P2H) roadmap: a review. The global energy market is in a transition towards low carbon fuel systems to ensure the sustainable development of our society and economy. This can be achieved by converting the surplus renewable energy into hydrogen gas. The injection of hydrogen (⩽10% v/v) in the existing natural gas pipelines is demonstrated to have negligible effects on the pipelines and is a promising solution for hydrogen transportation and storage if the end-user purification technologies for hydrogen recovery from hydrogen enriched natural gas (HENG) are in place. In this review, promising membrane technologies for hydrogen separation is revisited and presented. Dense metallic membranes are highlighted with the ability of producing 99.9999999% (v/v) purity hydrogen product. However, high operating temperature (⩾300 °C) incurs high energy penalty, thus, limits its application to hydrogen purification in the power to hydrogen roadmap. Polymeric membranes are a promising candidate for hydrogen separation with its commercial readiness. However, further investigation in the enhancement of H2/CH4 selectivity is crucial to improve the separation performance. The potential impacts of impurities in HENG on membrane performance are also discussed. The research and development outlook are presented, highlighting the essence of upscaling the membrane separation processes and the integration of membrane technology with pressure swing adsorption technology. Journal Article

A Dietary Sugarcane-Derived Polyphenol Mix Reduces the Negative Effects of Cyclic Heat Exposure on Growth Performance, Blood Gas Status, and Meat Quality in Broiler Chickens

2020-07-01T00:00:00Z

Shakeri, M; Cottrell, JJ; Wilkinson, S; Le, HH; Suleria, HAR; Warner, RD; Dunshea, FR 2020-07-01 A Dietary Sugarcane-Derived Polyphenol Mix Reduces the Negative Effects of Cyclic Heat Exposure on Growth Performance, Blood Gas Status, and Meat Quality in Broiler Chickens Heat stress (HS) compromises growth performance and meat quality of broiler chickens by interrupting lipid and protein metabolism, resulting in increased oxidative damages. The experiment attempted to investigate whether dietary polyphenols (Polygain (POL)) could ameliorate the aforementioned adverse effects of HS on performance and meat quality. One hundred and twenty one day-old-male chicks were allocated to two temperature conditions, thermoneutral (TN) or HS, and fed with either a control diet (CON) or the CON plus four different doses of POL (2, 4, 6 and 10 g/kg). Heat stress caused respiratory alkalosis as evidenced by increased rectal temperature (p < 0.001) and respiration rate (p < 0.001) due to increased blood pH (p < 0.001). Heat stress decreased final body weight (p = 0.061) and breast muscle water content (p = 0.013) while POL improved both (p = 0.002 and p = 0.003, respectively). Heat stress amplified muscle damages, indicated by increased thiobarbituric acid reactive substances (p < 0.001) and reduced myofibril fragmentation index (p = 0.006) whereas POL improved both (p = 0.037 and p = 0.092, respectively). Heat stress impaired meat tenderness (p < 0.001) while POL improved it (p = 0.003). In conclusion, HS impaired growth performance and meat quality whereas POL ameliorated these responses in a dose-dependent manner, and effects of POL were evident under both temperature conditions. Journal Article

Dietary Betaine Reduces the Negative Effects of Cyclic Heat Exposure on Growth Performance, Blood Gas Status and Meat Quality in Broiler Chickens

2020-05-01T00:00:00Z

Shakeri, M; Cottrell, JJ; Wilkinson, S; Le, HH; Suleria, HAR; Warner, RD; Dunshea, FR 2020-05-01 Dietary Betaine Reduces the Negative Effects of Cyclic Heat Exposure on Growth Performance, Blood Gas Status and Meat Quality in Broiler Chickens Heat stress (HS) impairs growth performance and has a severe impact on lipid and protein metabolism, leading to serious adverse effects on meat quality. Forty-eight day-old-male Ross-308 chicks were assigned to two temperature conditions, thermoneutral or cyclical HS, and fed with either a control diet (CON) or the CON plus betaine (BET). Heat stress increased rectal temperature (p < 0.001), respiration rate (p < 0.001) and increased blood pH (p = 0.017), indicating that HS caused respiratory alkalosis. Heat stress reduced body weight during the final stage of growing period (p = 0.005), while BET improved it (p = 0.023). Heat stress tended to reduce breast muscle water content and drip loss (p = 0.089 and p = 0.082), while both were improved with BET (p = 0.008 and p = 0.001). Heat stress tended to reduce the myofibril fragmentation index (p = 0.081) whereas it increased with BET (p = 0.017). Heat stress increased thiobarbituric acid reactive substances (p = 0.017), while BET improved it (p = 0.008). Meat tenderness was not affected by HS, but was improved with BET (p < 0.001). In conclusion, BET improved growth performance over the latter stages of the growing period, and improved product quality of broiler chickens when chickens exposed to HS. Journal Article

Examining longitudinal associations between self-reported depression, anxiety and stress symptoms and hair cortisol among mothers of young children

2020-12-01T00:00:00Z

Bryson, H; Middleton, M; Huque, H; Mensah, F; Goldfeld, S; Price, AMH 2020-12 Examining longitudinal associations between self-reported depression, anxiety and stress symptoms and hair cortisol among mothers of young children Journal Article

Group Identity, Performance Transparency, and Employee Performance

2020-09-01T00:00:00Z

Shang, R; Abernethy, M; Hung, C-Y 2020-09-01 Group Identity, Performance Transparency, and Employee Performance Economics, social psychology, and management studies suggest that group identity plays an important role in directing employee behaviors. On the one hand, strong group identity could motivate high effort by resolving conflicts of interests in the workplace. On the other hand, it could encourage conformity towards group norms. We examine whether the effect of group identity is conditional on managers' performance reporting choices. Drawing on survey and archival data from a field site, we find that when performance transparency is low, the interest alignment effect is more salient and group identity positively relates to employee performance. However, when performance transparency is high, the conformity effect is more salient and higher group identity is associated with more homogeneous, but not necessarily higher, employee performance. Our findings contribute to the management control literature by documenting that managers' performance reporting choices determine whether group identity has positive effects on employee performance. Journal Article

Feedbacks from human health to household reliance on natural resources during the COVID-19 pandemic

2020-10-01T00:00:00Z

Fiorella, KJ; Coffin-Schmitt, J; Gaynor, KM; Gregory, GH; Rasolofoson, R; Seto, KL 2020-10 Feedbacks from human health to household reliance on natural resources during the COVID-19 pandemic Journal Article

Anticipating the impacts of the COVID ‐19 pandemic on wildlife

2020-12-01T00:00:00Z

Gaynor, KM; Brashares, JS; Gregory, GH; Kurz, DJ; Seto, KL; Withey, LS; Fiorella, KJ 2020-12 Anticipating the impacts of the COVID ‐19 pandemic on wildlife Journal Article

Characterisation of Neutralising and Functional Antibody Responses to Different HIV-1 Env Vaccines in Bovines

2020-01-01T00:00:00Z

Salazar Quiroz, Natalia Andrea 2020 Characterisation of Neutralising and Functional Antibody Responses to Different HIV-1 Env Vaccines in Bovines Two main challenges have impeded the development of an effective HIV-1 envelope (Env) vaccine, with antibodies eliciting neutralisation of virions as well as Fc-effector functions, such as antibody-dependent cytotoxicity (ADCC), phagocytosis (ADP) or complement deposition (ADCD). On one hand, designing the right Env vaccine to elicit humoral or cellular protection has been challenging and, to date, SOSIP-Env trimers which are covalently constrained in the closed, pre-fusion conformation are the best vaccine candidate over uncleaved (Unc), open-structured trimers. On the other hand, eliciting heterologous neutralising antibodies in several animal models (including humans) has been difficult. Cows nevertheless produce unique antibodies with long CDRH3 regions, capable of accessing neutralising epitopes beneath the glycan shield, inaccessible for other animals. We tested how differences in clade and/or structure of HIV-1 Env vaccines affect the neutralising activity and Fc-effector functions of antibodies elicited, using recombinant trimers of clades A (KNH1,BG505), B (AD8, PSC89) and C (MW), which exposed either an open structure (Unc gp140) or a closed structure (SOSIP gp140). KNH1/BG505 SOSIP gp140 vaccine elicited the best neutralising IgGs against heterologous tier-2 pseudoviruses with high potency and breadth. While AD8 Unc gp140 also induced neutralisation, it was against only tier-1 pseudoviruses. Nevertheless, it was the only vaccine able to elicit IgGs that engaged CD32 (FcgRIIa), induced phagocytosis and complement-activation. The different antibody profile observed with both vaccines was explained by the Env immunogen structure, as KNH1/BG505 SOSIP gp140 induced mostly IgGs targeting the V1/V2 loop, whereas AD8 Unc gp140 induced antibodies targeting CD4-binding site and CD4-induced epitopes. In addition, analysis of IgG repertoires from animals of KNH1/BG505 SOSIP 100 and AD8 Unc 500 groups showed that KNH1/BG505 SOSIP gp140 induced higher rates of somatic hypermutation in germline genes compared to AD8 Unc gp140, with each animal presenting a unique antibody profile, and with germline antibodies already presenting high affinity towards HIV-1 Env trimers, as high levels of affinity maturation were not required to obtain antibodies with high neutralising activity. Overall, the results in this work show that open structured trimers elicit antibodies which highly activate antibody-effector functions, while SOSIP trimers focus antibody responses to concealed neutralising epitopes. The high neutralising responses observed in bovines against HIV-1 Env are due to antibodies which do not need high levels of somatic hypermutations and, in particular for KNH1/BG505 SOSIP, this antigen induced high levels of affinity maturation, probably favouring the improvement of both binding and neutralisation. Our study suggests that an effective vaccine regimen may include both uncleaved gp140 and SOSIP gp140, in order to target epitopes required for antibody-dependent effector functions as well as neutralisation, or a new trimeric structure with flexibility in the gp120-gp41 interface, exposing both epitopes involved in Fc-effector functions as well as neutralising ones. © 2020 Natalia Andrea Salazar Quiroz PhD thesis

Process compliance analysis based on behavioural profiles

2011-11-01T00:00:00Z

Weidlich, M; Polyvyanyy, A; Desai, N; Mendling, J; Weske, M 2011-11-01 Process compliance analysis based on behavioural profiles Process compliance measurement is getting increasing attention in companies due to stricter legal requirements and market pressure for operational excellence. In order to judge on compliance of the business processing, the degree of behavioural deviation of a case, i.e., an observed execution sequence, is quantified with respect to a process model (referred to as fitness, or recall). Recently, different compliance measures have been proposed. Still, nearly all of them are grounded on state-based techniques and the trace equivalence criterion, in particular. As a consequence, these approaches have to deal with the state explosion problem. In this paper, we argue that a behavioural abstraction may be leveraged to measure the compliance of a process log – a collection of cases. To this end, we utilise causal behavioural profiles that capture the behavioural characteristics of process models and cases, and can be computed efficiently. We propose different compliance measures based on these profiles, discuss the impact of noise in process logs on our measures, and show how diagnostic information on non-compliance is derived. As a validation, we report on findings of applying our approach in a case study with an international service provider. Journal Article