Research Results (GHRI) / Résultats de recherches (IRSM)
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Item Processus de décentralisation et leurs incidences sur les services sociaux en Afrique de l'ouest et du centre - rapport technique final(Programme de développement municipal, Cotonou, BJ, 2000) Finken, Martin; Elong Mbassi, Jean-PierreItem Processus de décentralisation et leurs incidences sur les services sociaux en Afrique de l'ouest et centrale : rapport de recherche(Programme de développement municipal, Cotonou, BJ, 2000) Equipe du Burkina Faso; Progamme de développement municipal; Groupe de recherche sur les initiatives localesItem Processus de décentralisation et leurs incidences sur les services sociaux en Afrique de l'ouest et du centre : les annexes au rapport final(Progamme de développement municipal, Cotonou, BJ, 2000) Finken, Martin; Elong Mbassi, Jean-PierreItem Processus de décentralisation et leurs incidences sur les services sociaux en Afrique de l'ouest et du centre : annexes au rapport final de l'Equipe de Côte d'Ivoire(Programme de développement municipal, Cotonou, BJ, 2000) Centre pour la démocratie et les droits de la personneItem Processus de décentralisation et leurs incidences sur les services sociaux de santé et d'éducation : rapport final de recherche(Ecole nationale supérieure polytechnique, Yaoundé, CM, 2000) Tanawa, Emile; Noumba, Issidor; Mandessi Bell, Evelyne; Yimgaing Moyo, Théophile; Bopda, Athanase; Ecole nationale supérieure polytechniqueItem Processus de décentralisation et leurs incidences sur les services sociaux en Afrique de l'ouest et du centre : rapport final de l'Equipe de Côte d'Ivoire(Progamme de développement municipal, Cotonou, BJ, 2000) Centre pour la démocratie et les droits de la personne; Progamme de développement municipalItem Household cost-benefit equations and sustainable universal childhood immunization : a randomised cluster controlled trial in South Pakistan(BioMed Central, London, GB, 2005) Andersson, Neil; Cockcroft, Anne; Ansari, Noor; Omer, Khalid; Losos, JoeBackground: 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 follow-up 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.Item Prospective Study of One Million Deaths in India: Rationale, Design, and Validation Results(2005-12) Jha, Prabhat; Vendhan Gajalakshmi, Vendhan; Gupta, Prakash C; Kumar, Rajesh; Mony, PremBackground: Over 75% of the annual estimated 9.5 million deaths in India occur in the home, and the large majority of these do not have a certified cause. India and other developing countries urgently need reliable quantification of the causes of death. They also need better epidemiological evidence about the relevance of physical (such as blood pressure and obesity), behavioral (such as smoking, alcohol, HIV-1 risk taking, and immunization history), and biological (such as blood lipids and gene polymorphisms) measurements to the development of disease in individuals or disease rates in populations. We report here on the rationale, design, and implementation of the world’s largest prospective study of the causes and correlates of mortality. Methods and Findings: We will monitor nearly 14 million people in 2.4 million nationally representative Indian households (6.3 million people in 1.1 million households in the 1998–2003 sample frame and 7.6 million people in 1.3 million households in the 2004–2014 sample frame) for vital status and, if dead, the causes of death through a well-validated verbal autopsy (VA) instrument. About 300,000 deaths from 1998–2003 and some 700,000 deaths from 2004–2014 are expected; of these about 850,000 will be coded by two physicians to provide causes of death by gender, age, socioeconomic status, and geographical region. Pilot studies will evaluate the addition of physical and biological measurements, specifically dried blood spots. Preliminary results from over 35,000 deaths suggest that VA can ascertain the leading causes of death, reduce the misclassification of causes, and derive the probable underlying cause of death when it has not been reported. VA yields broad classification of the underlying causes in about 90% of deaths before age 70. In old age, however, the proportion of classifiable deaths is lower. By tracking underlying demographic denominators, the study permits quantification of absolute mortality rates. Household case-control, proportional mortality, and nested case-control methods permit quantification of risk factors. Conclusions: This study will reliably document not only the underlying cause of child and adult deaths but also key risk factors (behavioral, physical, environmental, and eventually, genetic). It offers a globally replicable model for reliably estimating cause-specific mortality using VA and strengthens India’s flagship mortality monitoring system. Despite the misclassification that is still expected, the new cause-of-death data will be substantially better than that available previously.Item Low male-to-female sex ratio of children born in India: national survey of 1.1 million households(2006-01) Jha, P; Kumar, R; Vasa, P; Dhingra, N; Thiruchelvam, DBackground: Fewer girls than boys are born in India. Various hypotheses have been proposed to explain this low sex ratio. Our aim was to ascertain the contribution of prenatal sex determination and selective abortion as measured by previous birth sex. Methods: We analysed data obtained for the Special Fertility and Mortality Survey undertaken in 1998. Ever-married women living in 1.1 million households in 6671 nationally-representative units were asked questions about their fertility history and children born in 1997. Findings: For the 133 738 births studied for 1997, the adjusted sex ratio for the second birth when the preceding child was a girl was 759 per 1000 males (99% CI 731—787). The adjusted sex ratio for the third child was 719 (675—762) if the previous two children were girls. By contrast, adjusted sex ratios for second or third births if the previous children were boys were about equal (1102 and 1176, respectively). Mothers with grade 10 or higher education had a significantly lower adjusted sex ratio (683, 610—756) than did illiterate mothers (869, 820—917). Stillbirths and neonatal deaths were more commonly male, and the numbers of stillbirths were fewer than the numbers of missing births, suggesting that female infanticide does not account for the difference. Interpretation: Prenatal sex determination followed by selective abortion of female fetuses is the most plausible explanation for the low sex ratio at birth in India. Women most clearly at risk are those who already have one or two female children. Based on conservative assumptions, the practice accounts for about 0·5 million missing female births yearly, translating over the past 2 decades into the abortion of some 10 million female fetuses.Item Strengthening health care systems for HIV and AIDS in sub-Saharan Africa and the Caribbean: a program of research(2007) Edwards, N; Kahwa, E; Kaseje, D; Mill, J; Webber, JItem Renforcement des capacités et transfert des connaissances : le Programme de partenariat Teasdale-Corti de recherche en santé mondiale(CRDI, Ottawa, ON, CA, 2007) Eggertson, LauraItem Building capacity and transferring knowledge : the Teasdale-Corti global health research partnership program(IDRC, Ottawa, ON, CA, 2007) Eggertson, LauraItem Création d'une nouvelle génération d'études épidemiologiques en santé mentale(2007) Caron, J; Tousignant, M; Pedersen, D; Fleury, M J; Cargo, MGrâce à une subvention des Instituts de recherche en santé du Canada (IRSC), il se développe actuellement une nouvelle génération d’études en épidémiologie sociale et psychiatrique dans une zone circonscrite se situant dans le sud-ouest de Montréal où vivent 258 000 personnes. Ce programme de recherche repose sur une étude prospective longitudinale visant à identifier les déterminants de la santé mentale de la population, et sur quatre études spécifiques qui abordent des paramètres importants pour la santé mentale : l’écologie sociale et physique des quartiers, le soutien social, le stigma social et les services en santé mentale. Ce programme est complété par l’utilisation de la dernière génération des outils technologiques et informatiques soit un système d’information géographique (SIG) qui permet d’apprécier les effets du contexte sur la santé mentale. Les bases théoriques sur lesquels repose ce modèle sont présentées de même qu’une description sommaire des méthodes utilisées.Item Assessing the impact of HIV/AIDS on health service capacity at primary care level, with specific focus on human resource capacity(2007) Lehmann, Uta; Schaay, Nikki; Zulu, Jabu; Matwa, Princess; Mathews, Verona; Daviaud, Emmanuelle; Scott, Vera; Dayile, NomvuyoThe project investigates how HIV/AIDS is impacting primary health care (PHC) services, especially human resources. It also reveals community participation components that can mitigate impacts. An assessment and management (audit) tool for managers was developed during the study. While research is needed to support and advance service development, the capacity to accommodate and absorb research is often very limited. The audit tool developed in Cape Town is now a well-established management tool which has national support. Leadership was found to be a crucial ingredient in capacity for change.Item Psychosocial Counselling in Nepal: Perspectives of Counsellors and Beneficiaries(2007-02) Jordans, Mark J; Keen, Annalise S; Pradhan, Hima; Tol, Wietse AThe aims of this qualitative study were (1) to add to the understanding of the growing field of psychosocial counselling in Nepal, and (2) gather concrete points for improvement of services. Semi-structured interviews were conducted with clients (n=34), para-professional counsellors (n=26) and managers (n=23) of organizations in which psychosocial counselling was taking place. The main findings were that stakeholders generally presented a positive view of the significance and supportive function of psychosocial counselling, while providing useful suggestions for improvement. Matters of ongoing training and supervision, confidentiality and integration of counselling within mainstream care provision need to be addressed and potentially adapted. Implications for other non-Western countries with little mental health resources are discussed.Item Human resource management in the Georgian National Immunization Program: a baseline assessment(2007-07) Esmail, Laura C; Cohen-Kohler, Jillian Clare; Djibuti, MamukaBackground: Georgia's health care system underwent dramatic reform after gaining independence in 1991. The decentralization of the health care system was one of the core elements of health care reform but reports suggest that human resource management issues were overlooked. The Georgian national immunization program was affected by these reforms and is not functioning at optimum levels. This paper describes the state of human resource management practices within the Georgian national immunization program in late 2004. Methods: Thirty districts were selected for the study. Within these districts, 392 providers and thirty immunization managers participated in the study. Survey questionnaires were administered through face-to-face interviews to immunization managers and a mail survey was administered to immunization providers. Qualitative data collection involved four focus groups. Analysis of variance (ANOVA) and Chi-square tests were used to test for differences between groups for continuous and categorical variables. Content analysis identified main themes within the focus groups. Results: Weak administrative links exist between the Centres of Public Health (CPH) and Primary Health Care (PHC) health facilities. There is a lack of clear management guidelines and only 49.6% of all health providers had written job descriptions. A common concern among all respondents was the extremely inadequate salary. Managers cited lack of authority and poor knowledge and skills in human resource management. Lack of resources and infrastructure were identified as major barriers to improving immunization. Conclusion: Our study found that the National Immunization Program in Georgia was characterized by weak organizational structure and processes and a lack of knowledge and skills in management and supervision, especially at peripheral levels. The development of the skills and processes of a well-managed workforce may help improve immunization rates, facilitate successful implementation of remaining health care reforms and is an overall, wise investment. However, reforms at strategic policy levels and across sectors will be necessary to address the systemic financial and health system constraints impeding the performance of the immunization program and the health care system as a whole.Item Lacor Hospital Capacity - Strengthening Project(2007-08) Lacor Hospital; Antony Land AssociatesThe project identified Lacor Hospital’s role in the national health system of the country and in the pacification and development process of the area where it operates (North Uganda). At the centre of a vast area that has been ravaged by a 20-year long civil war, Lacor Hospital is the largest and the most advanced Private Not For Profit (PNFP) Hospital in upcountry Uganda. PNFP Hospitals provide about 40% of Hospital services and work together with local governments in delivering the Uganda National Minimum Health Care Package (UNMHCP). They also play a crucial role in training health workers.Item Forger des partenariats - Jeter des ponts(2007-10) Murphy, LindaLe Canada sera un chef de file mondial en appuyant la recherche transdisciplinaire en santé mondiale et ses applications et en favorisant des collaborations Sud Nord équitables, le renforcement des capacités institutionnelles, l’élaboration de politiques fondées sur des données probantes et l’exécution de programmes visant à améliorer la santé et le bien être des Canadiens et des citoyens des pays à faible revenu et des pays à revenu intermédiaire (PFR-PRI*).Item Forging Partnerships - Building Bridges(2007-10) Murphy, LindaCanada will be a world leader in supporting transdisciplinary global health research and its application, fostering equitable South-North collaborations, institutional capacity building and evidence-informed policies and programs that improve the health and well-being of Canadians and citizens of low- and middle-income countries (LMICs*).