Developing Scales for Measuring Gender Behaviors in Reproductive Health in Rural China

This article introduces two scales for measuring the gender-specific burden of family planning (FP) and reproductive health (RH) in rural China, following the implementation of a client-oriented approach to FP/RH. One scale (GHRHS-SC) measures FP/RH clients to examine whether gender influences FP/RH behaviors. The other scale (GHRHS-SP) measures service provider interactions with service clients to gauge whether FP/RH institutions are fulfilling the client-oriented mandate. The content of scales was developed through inductive analysis conducted on data generated from focus groups and in-depth interviews. The validation of the scales was confirmed with item analysis, exploratory factor analysis, and confirmatory factor analysis. To generate data for validation purposes, we employed a stratified cluster sampling method for a sample of service providers and a stratified multistage method for a sample of service clients. The analytical results indicate that the scales possess good internal consistency, reliability, and overall validity. The construct validity for the GHRHS-SP needs some improvement. Both the GHRHS-SC and GHRHS-SP are valid instruments for measuring gender differences in FP/RH behavior, though further refinements would be beneficial.     

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings

Objective

To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services.

Design

A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland.

Methods

Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars.

Results

The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity.

Conclusion

For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements.     

The Ethics of Engaged Presence: A Framework for Health Professionals in Humanitarian Assistance and Development Work

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships.     

The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review

Background

Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant women to reach health facilities during an emergency, after the decision to seek care is made.

Methods and findings

Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials and quasi experimental study designs with a comparison group were included. Outcomes of interest included maternal and neonatal mortality and other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, and extracted articles using predefined fields. Forest plots, tables, and qualitative summaries of study quality, size, and direction of effect were used for analysis.Nineteen studies were included. In South Asian settings, four studies of organisational interventions in communities that generated funds for transport reduced neonatal deaths, with the largest effect seen in India (odds ratio 0·48 95% CI 0·34–0·68). Three quasi experimental studies from sub-Saharan Africa reported reductions in stillbirths with maternity waiting home interventions, with one statistically significant result (OR 0.56 95% CI 0.32–0.96). Effects of interventions on maternal mortality were unclear. Referral interventions usually improved utilisation of health services but the opposite effect was also documented. The effects of multiple interventions in the studies could not be disentangled. Explanatory mechanisms through which the interventions worked could not be ascertained.

Conclusions

Community mobilisation interventions may reduce neonatal mortality but the contribution of referral components cannot be ascertained. The reduction in stillbirth rates resulting from maternity waiting homes needs further study. Referral interventions can have unexpected adverse effects. To inform the implementation of effective referral interventions, improved monitoring and evaluation practices are necessary, along with studies that develop better understanding of how interventions work. Please see later in the article for the Editors'' Summary     

Developing Conceptual Categories in Classroom Descriptive Research: Some Problems and Possibilities

This article reflects on a classroom study of children's literary responses to unpack the process of building conceptual categories in ethnographic research, thus challenging accounts that obscure the role of the researcher and present findings as fixed and infallible.     

Developing Capacities of Community Health Workers in Sexual and Reproductive,Maternal, Newborn,Child, and Adolescent Health: A Mapping and Review of Training Resources

Background

Given country demands for support in the training of community health workers (CHWs) to accelerate progress towards reaching the Millennium Development Goals in sexual and reproductive health and maternal, newborn, child, and adolescent health (SR/MNCAH), the United Nations Health Agencies conducted a synthesis of existing training resource packages for CHWs in different components of SR/MNCAH to identify gaps and opportunities and inform efforts to harmonize approaches to developing the capacity of CHWs.

Methods

A mapping of training resource packages for CHWs was undertaken with documents retrieved online and from key informants. Materials were classified by health themes and analysed using agreed parameters. Ways forward were informed by a subsequent expert consultation.

Results

We identified 31 relevant packages. They covered different components of the SR/MNCAH continuum in varying breadth (integrated packages) and depth (focused packages), including family planning, antenatal and childbirth care (mainly postpartum haemorrhage), newborn care, and childhood care, and HIV. There is no or limited coverage of interventions related to safe abortion, adolescent health, and gender-based violence. There is no training package addressing the range of evidence-based interventions that can be delivered by CHWs as per World Health Organization guidance. Gaps include weakness in the assessment of competencies of trainees, in supportive supervision, and in impact assessment of packages. Many packages represent individual programme efforts rather than national programme materials, which could reflect weak integration into national health systems.

Conclusions

There is a wealth of training packages on SR/MNCAH for CHWs which reflects interest in strengthening the capacity of CHWs. This offers an opportunity for governments and partners to mount a synergistic response to address the gaps and ensure an evidence-based comprehensive package of interventions to be delivered by CHWs. Packages with defined competencies and methods for assessing competencies and supervision are considered best practices but remain a gap.     

Exploring Wellness of Wildlife Carers in New Zealand: A Descriptive Study

The rescue and care of vulnerable wildlife is rewarding. Most people involved in animal rescue have a strong commitment to service but the work can be profoundly challenging. The ability to know and respond appropriately to an animal's needs depends on the professional skills and knowledge of wildlife carers. In the face of unrelenting suffering and countless numbers of animals in need, there are multiple stressors, vulnerabilities, and barriers that can undermine carers’ wellbeing and put them at risk of compassion fatigue. The balance between compassion satisfaction and compassion fatigue is considered professional quality of life. The aim of this study was to provide a preliminary understanding of the potential for compassion satisfaction and the risk of compassion fatigue among wildlife carers within New Zealand. Thirty wildlife carers voluntarily completed a self-report survey, which included questions on socio-demographics, self-perceived quality of life (EUROHIS-QOL), professional quality of life (ProQOL), job satisfaction, motivation for ongoing work in wildlife rehabilitation, and coping mechanisms. We found that there were significant differences in compassion satisfaction and compassion fatigue on the basis of age, gender, financial capability, and years of experience. Overall, this sample showed high levels of compassion satisfaction and low levels of compassion fatigue. Understanding the elements of professional quality of life can have a positive effect on work environment. These results may provide clues to help identify wildlife carers’ strengths for compassion satisfaction and vulnerabilities to compassion fatigue, and to help develop strategies to improve their professional quality of life.     

Institutional Development in the Face of Complexity: Developing Rules for Managing Forest Resources

The ability to develop institutions is constrained by human capacity to cope with complexity. But complexity is multidimensional and it is not clear which forms of complexity present the greatest challenges for institutional development. In the context of natural resources, the predictability of resource availability affects expectations that an individual or group will be able to capture the benefits of management. In addition, incomplete understanding of cause-and-effect relationships creates uncertainty about the consequences of alternative management options. These features influence calculations about resource management. The importance of resource complexity relative to various social, political, and institutional factors known to influence collective choice remains an open question. We evaluate the relative importance of several forms of resource complexity and characteristics of resource users for the development of rules for management for forest products in Indiana.     

Human Rabies in China, 1960-2014: A Descriptive Epidemiological Study

BackgroundRabies in China remains a public health problem. In 2014, nearly one thousand rabies-related deaths were reported while rabies geographic distribution has expanded for the recent years. This report used surveillance data to describe the epidemiological characteristics of human rabies in China including determining high-risk areas and seasonality to support national rabies prevention and control activities.MethodsWe analyzed the incidence and distribution of human rabies cases in mainland China using notifiable surveillance data from 1960–2014, which includes a detailed analysis of the recent years from 2004 to 2014.ResultsFrom 1960 to 2014, 120,913 human rabies cases were reported in mainland China. The highest number was recorded in 1981(0.7/100,000; 7037 cases), and in 2007(0.3/100,000; 3300 cases). A clear seasonal pattern has been observed with a peak in August (11.0% of total cases), Human rabies cases were reported in all provinces with a yearly average of 2198 from 1960 to 2014 in China, while the east and south regions were more seriously affected compared with other regions. From2004 to 2014, although the number of cases decreased by 65.2% since 2004 from 2651 to 924 cases, reported areas has paradoxically expanded from 162 prefectures to 200 prefectures and from southern to the central and northern provinces of China. Farmers accounted most of the cases (65.0%); 50–59 age group accounted for the highest proportion (20.5%), and cases are predominantly males with a male-to-female ratio of 2.4:1 on average.ConclusionsDespite the overall steady decline of cases since the peak in 2007, the occurrence of cases in new areas and the spread trend were obvious in China in recent years. Further investigations and efforts are warranted in the areas have high rabies incidence to control rabies by interrupting transmission from dogs to humans and in the dog population. Furthermore, elimination of rabies should be eventually the ultimate goal for China.     

Changing Male Reproductive Health: A Review of the Clinical Evidence?

Several lines of circumstantial evidence suggest that we may be seeing adverse changes in male reproductive health. A possible decline in semen quality has attracted most attention, but there are stronger indications of a rising incidence of testicular cancer, with increases observed in both Europe and the USA. There are striking geographic variations in both the incidence of testis cancer and in the observed rate of increase, and it is noteworthy that testis cancer is much more common in Denmark, where low sperm counts have been reported, than in Finland, where semen quality seems to be better. Another cause for concern is the rising incidence of congenital malformations of the male genital tract — cryptorchidism and hypospadias. In the UK, for example, rates of cryptorchidism have increased by as much as 65 to 77%. The data are harder to interpret on semen quality. In a meta-analysis, Carlsen et al. (1992) identified significant decreases over time in sperm concentration, corresponding to a fall of almost 50% between 1940 and 1990. Several groups have since examined secular trends in semen quality, with some reporting a downward trend and others no change. However, evidence has emerged of striking regional differences in semen quality, whether due to ethnic, genetic, environmental, or lifestyle factors remains to be determined.