1.  Title: Human resources for health in the low-resource world: collaborative practice and task shifting in maternal and neonatal care. Author: FIGO Safe Motherhood and Newborn Health Committee Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):74-6. Abstract: An important barrier to the attainment of Millennium Development Goals (MDGs) 4 and 5 in many countries is the lack of trained and skilled clinical staff who can provide timely and high-quality care to mothers with pregnancy complications. This article presents guidelines and recommendations on how to better make use of existing health human resources in order to improve maternal and neonatal care. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | MATERNAL-CHILD HEALTH SERVICES | HUMAN RESOURCES | GYNECOLOGY | OBSTETRICS | OBSTETRICAL SURGERY | TRAINING PROGRAMS | Delivery of Health Care | Health | Primary Health Care | Health Services | Economic Factors | Medicine | Surgery | Treatment | Medical Procedures | Education Document Number: 341381 |
2.  Title: After receiving USAID | DELIVER Project logistics training, access to health products improves in Nepal. Author: John Snow [JSI]. DELIVER Source: Arlington, Virginia, JSI, DELIVER, 2009 Jul. [2] p. (Success Story) Abstract: Just three years ago, under the previous health commodity distribution system in Nepal, the average stockout rate for family planning was 8.2 percent; for maternal and child health commodities it was 22.9 percent. Many women and children did not have the health commodities they needed. To prevent stockouts and to increase the availability of health commodities nationwide, the USAID | DELIVER PROJECT partnered with the Government of Nepal / Ministry of Health and Population (Logistics Management Division / Department of Health Services [LMD / DOHS]) and others to develop a series of logistics training programs. The goal was to create an efficient pull system that the country could use to manage stock levels at all health facilities. The project and the LMD collaborated to successfully implement two training programs -- one for community logistics and one for web-based logistics management information systems (LMISs). Conducted by the Nepali government, the USAID | DELIVER PROJECT, and their partners, these trainings taught community and district health workers how to improve the national health commodity logistics system and how to ease the transition to the new district-level pull system, which allows each health facility to determine the amount of stock that it needs to order. As a result, after 25 of the poorly performing districts participated in the training programs, stockouts of key commodities in their health facilities -- condoms, vitamin A capsules, iron tablets, cotrimoxazole, oral rehydration salt, and oxytocin decreased, while product availability for the end user increased. (Excerpt) Language: English Keywords: NEPAL | SUMMARY REPORT | COMMUNITY-BASED DISTRIBUTION WORKERS | USAID | LOGISTICS | DISTRIBUTIONAL ACTIVITIES | TRAINING PROGRAMS | INFORMATION RETRIEVAL SYSTEMS | INTERNET | HEALTH FACILITIES | PERFORMANCE IMPROVEMENT | Developing Countries | Asia, Southern | Asia | Community Workers | Health Personnel | Delivery of Health Care | Health | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Program Activities | Programs | Education | Data Storage and Retrieval | Information Processing | Information | Information Networks | Communication Document Number: 331664 |
| 3. Peer Reviewed Title: Provision of abortion by mid-level providers: international policy, practice and perspectives. Author: Berer M Source: Bulletin of the World Health Organization. 2009 Jan;87(1):58-63. Abstract: Based on articles found on the PubMed and Popline databases on the provision of first-trimester abortion by mid-level providers, this article describes policies on type of abortion provider, comparative studies of different types of abortion provider, provider perspectives, and programmatic experience in Bangladesh, Cambodia, France, Mozambique, South Africa, Sweden, the United States of America and Viet Nam. It shows that it is safe and beneficial for suitably trained mid-level health-care providers, including nurses, midwives and other non-physician clinicians, to provide first-trimester vacuum aspiration and medical abortions. Moreover, it finds that projects in Kenya, Myanmar and Uganda have successfully trained nurse-midwives to provide post-abortion care for incomplete abortion with manual vacuum aspiration, and that studies in Ethiopia and India have recommended that providers such as auxiliary nurse-midwives should be trained in abortion service delivery to ensure that they provide safe abortions for low-income women. The paper recommends the authorization of all qualified mid-level health-care providers to carry out first-trimester abortions, and it also recommends the integration of training in providing first-trimester abortion care into basic education and clinical training for all mid-level providers and medical students interested in obstetrics and gynaecology. Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice. Language: English Keywords: DEVELOPING COUNTRIES | DEVELOPED COUNTRIES | RECOMMENDATIONS | COMPARATIVE STUDIES | CLINICAL RESEARCH | HEALTH PERSONNEL | ABORTION | PREGNANCY, FIRST TRIMESTER | POSTABORTION CARE | TRAINING PROGRAMS | Studies | Research Methodology | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Health Services | Education Document Number: 341127 |
| 4. Title: Placing learning needs in context: distance learning for clinical officers in Tanzania. Author: Brigley S; Hosein I; Myemba I Source: Medical Teacher. 2009 Apr;31(4):e169-76. Abstract: BACKGROUND: Poor public health indicators in Tanzania have led to the upgrading of nursing and clinical personnel who currently have just core training. Clinical officers (COs) have 3 years training in basic and applied medicine and are responsible for healthcare of large and dispersed rural populations. AIMS: UNESCO-Wales has funded colleagues in Wales (UK) to assist the upgrade of COs. An inquiry into their learning needs and the Tanzanian context has produced a framework for design of a module for COs on sexually transmissible infections and HIV & AIDS by distance learning. METHODS: Face-to-face discussions were held with the Ministry of Health, healthcare workers, educators and administrators in Tanzania; a review of training documents was carried out; and a follow-up questionnaire issued to COs. RESULTS: The discussions and review highlighted teacher-centred approaches, and management, infrastructure and resources obstacles to curriculum change. Principal learning needs of COs around STIs were: counselling, syndromic management, drugs management, laboratory diagnosis, health education, resources, staffing and service morale. CONCLUSIONS: Placing learning needs in context in dialogue with Tanzanian colleagues was an advance on simple transfer of educational technologies and expertise. The inquiry resulted in a draft study guide and resources pack that were positively reviewed by Tanzanian tutors. Management and resources issues raised problems of sustainability in the module implementation. Language: English Keywords: TANZANIA | SUMMARY REPORT | HEALTH PERSONNEL | DISTANCE EDUCATION | TRAINING PROGRAMS | NEEDS | UNESCO | CURRICULUM | SEXUALLY TRANSMITTED DISEASES | HIV INFECTIONS | AIDS | TREATMENT | OBSTACLES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Education | Economic Factors | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Medical Procedures | Medicine | Health Services | Organization and Administration Document Number: 341949 |
| 5. Title: Impact of a peer-group intervention on occupation-related behaviors for urban hospital workers in Malawi. Author: Chimango JL; Kaponda CN; Jere DL; Chimwaza A; Crittenden KS; Kachingwe SI; Norr KF; Norr JL Source: Journal of the Association of Nurses In AIDS Care. 2009 Jul-Aug;20(4):293-307. Abstract: Using a pre- and posttest design with no control group, the authors evaluated the impact of a peer-group intervention on work related knowledge and behavior for health workers at an urban hospital in Malawi. The authors surveyed unmatched random samples of health workers, observed workers on the job, and interviewed clients about hospital services at baseline and at 6 months after the intervention. Universal precautions knowledge, reported hand washing, and reported client teaching were significantly higher at the final evaluation. The outcome differences remained robust in multivariate analyses with controls for demographic factors of age, gender, education, food security, and job category. Observations reported consistently greater use of universal precautions, more respectful interactions, and more client teaching at final evaluation. Patient surveys reported more discussion with health workers about HIV at the final evaluation. Peer-group interventions can prepare health workers in Malawi for HIV prevention and offer a potential model for other African countries. Language: English Keywords: MALAWI | RESEARCH REPORT | SAMPLING STUDIES | URBAN POPULATION | HEALTH PERSONNEL | PEER EDUCATORS | HIV PREVENTION | INTERVENTIONS | HOSPITALS | TRAINING PROGRAMS | UNIVERSAL PRECAUTIONS | KNOWLEDGE | HANDWASHING | INTERPERSONAL RELATIONS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Education | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Health Facilities | Safety | Public Health | Sociocultural Factors | Hygiene | Behavior Document Number: 342814 |
| 6. Peer Reviewed Title: Surgical task shifting in Sub-Saharan Africa. Author: Chu K; Rosseel P; Gielis P; Ford N Source: PLoS Medicine. 2009 May 19;6(5):e1000078. Abstract: Surgically treatable problems account for a significant proportion of disease burden in resourcelimited settings, but are neglected due to lack of skilled professionals, adequate infrastructure and equipment, and the perception that surgical services are complex and expensive. In the absence of trained surgeons, surgical tasks are often performed by non-specialist physicians and non-physician clinicians. While evaluations have proven the effectiveness of such task shifting, this is often done de facto, with little supervisory or training framework in place. As efforts increase to scale up surgical care in the developing world, a number of important lessons from task shifting in the field of HIV/AIDS care could serve to support task shifting in surgery. These include clearly defining the limits of task shifting, ensuring adequate training and supervision, providing adequate recognition and remuneration, developing simplified tools and guidelines, ensuring engagement with regulatory bodies, and mobilizing community health workers. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | HEALTH PERSONNEL | SURGERY | ANESTHESIA | HUMAN RESOURCES | TRAINING PROGRAMS | AIDS | HIV INFECTIONS | REFERRAL AND CONSULTATION | SUPERVISION | ETHICS | Africa | Developing Countries | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Health Services | Economic Factors | Education | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Management | Sociocultural Factors Document Number: 341772 |
| 7. Peer Reviewed Title: Task shifting for emergency obstetric surgery in district hospitals in Senegal. Author: De Brouwere V; Dieng T; Diadhiou M; Witter S; Denerville E Source: Reproductive Health Matters. 2009 May;17(33):32-44. Abstract: Due to a long-term shortage of obstetricians, the Ministry of Health of Senegal and Dakar University Obstetric Department agreed in 1998 to train district teams consisting of an anaesthetist, general practitioner and surgical assistant in emergency obstetric surgery. An evaluation of the policy was carried out in three districts in 2006, covering trends in rates of major obstetric interventions, outcomes in newborns and mothers, and the views of key informants, community members and final year medical students. From 2001 to 2006, 11 surgical teams were trained but only six were functioning in 2006. The current rate of training is not rapid enough to cover all districts by 2015. An increase in the rate of interventions was noted as soon as a team had been put in place, but unmet need persisted. Central decision-makers considered the policy more viable than training gynaecologists for district hospitals, but resistance from senior academic clinicians, a perceived lack of career progression among the doctors trained, and lack of programme coordination were obstacles. Practitioners felt the work was valuable, but complained of low additional pay and not being replaced during training. Communities appreciated that the services saved lives and money, but called for improved information and greater continuity of care. Spanish Abstract: Debido a la prolongada escasez de obstetras, el Ministerio de Salud de Senegal y el Departamento Obstétrico de la Universidad de Dakar acordaron, en 1998, capacitar a equipos distritales integrados por un anestesista, un médico general y un auxiliar quirúrgico en cirugía obstétrica de emergencia. En 2006, se realizó una evaluación de la política en tres distritos, donde se examinaron las tendencias en las tasas de intervenciones obstétricas importantes, los resultados en recién nacidos y madres, y los puntos de vista de informantes clave, miembros de la comunidad y estudiantes de medicina en su último año académico. Del 2000 al 2006, 11 equipos quirúrgicos fueron capacitados, pero sólo seis funcionaban en 2006. El ritmo actual de capacitación no es suficientemente rápido para abarcar todos los distritos al cabo del 2015. Se observó un aumento en el índice de intervenciones tan pronto se establecía un equipo, pero la necesidad insatisfecha persistió. Las autoridades decisorias centrales estimaron que esta política era más viable que capacitar ginecólogos en los hospitales distritales. Entre los obstáculos figuraban la resistencia de los médicos académicos sénior, la percibida falta de ascenso profesional entre los médicos capacitados y la falta de coordinación del programa. Los médicos estimaron el trabajo valioso, pero se quejaban de la baja paga adicional y de no ser sustituidos durante la capacitación. Las comunidades estaban agradecidas porque los servicios salvaron vidas y ahorraron dinero, pero solicitaron mejor información y mayor continuidad de servicios. French Abstract: Face au manque d'obstétriciens à long terme, le Ministère sénégalais de la santé et le Département d'obstétrique de l'Université de Dakar ont convenu en 1998 de former des équipes de district composées d'un anesthésiste, d'un médecin généraliste et d'un assistant en chirurgie obstétricale d'urgence. En 2006, une évaluation de la politique a été menée dans trois districts pour analyser les tendances des principales interventions obstétricales, les résultats pour les nouveau-nés et les mères et les opinions des informateurs clés, des membres des communautés et des étudiants en dernière année de médecine. De 2001 à 2006, 11 équipes chirurgicales ont été formées mais six seulement fonctionnaient encore en 2006. Le rythme actuel de formation n'est pas assez rapide pour couvrir tous les districts d'ici à 2015. Une augmentation du taux d'interventions a été notée dès la mise en place d'une équipe, mais les besoins insatisfaits demeuraient. Pour les décideurs centraux, cette politique était plus viable que la formation de gynécologues pour les hôpitaux de district, mais elle se heurtait à la résistance des professeurs cliniciens, à un manque perçu de possibilités d'avancement pour les médecins formés et à une coordination insuffisante entre programmes. Les praticiens estimaient que le travail était utile, mais déploraient la faible rémunération complémentaire et regrettaient de ne pas être remplacés pendant la formation. Les communautés se félicitaient que les services sauvent des vies et économisent de l'argent, mais demandaient davantage d'information et une plus grande continuité des soins. Language: English Keywords: SENEGAL | RESEARCH REPORT | HEALTH PERSONNEL | EMERGENCY SERVICES | OBSTETRICAL SURGERY | HOSPITALS | CESAREAN SECTION | TRAINING PROGRAMS | PROGRAM EVALUATION | HEALTH POLICY | OBSTACLES | UTILIZATION OF HEALTH CARE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Health Services | Surgery | Treatment | Medical Procedures | Medicine | Health Facilities | Education | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors Document Number: 342013 |
| 9. Title: Youth as research fieldworkers in a context of HIV/AIDS Author: Francis D; Hemson C Source: African Journal of AIDS Research. 2009;8(2):223-230. Abstract: While youth-to-youth research approaches have increased in both popularity and practice, our understanding of the processes and mechanisms underlying the successes or failures of 'peer researchers' is still developing. This study addresses the question through qualitative research, drawing on observations of the process of training out-of-school youths as research fieldworkers, reflections on the interviews with respondents, and focus group discussions with the young fieldworkers. The authors found several advantages to using fieldworkers who are close in their characteristics to that of respondents. These benefits included ready access to respondents, the immediate use of language appropriate to the respondents, and an ability to swiftly establish rapport. They authors also observed several limitations: the peer researchers struggled with the wish of some respondents to establish supportive friendships with them, they lacked the authority of an academic researcher, and they sometimes resorted to false promises in attempts to get cooperation. The authors conclude that using youths as peer researchers is neither better nor worse than using professional researchers, but each approach can produce its own challenges and possibilities. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RESEARCH METHODOLOGY | QUALITATIVE RESEARCH | OUT-OF-SCHOOL YOUTHS | INTERVIEWERS | PEER GROUPS | HIV INFECTIONS | TRAINING PROGRAMS | POWER | INTERPERSONAL RELATIONS | LANGUAGE | ETHICS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Survey Personnel | Surveys | Sampling Studies | Studies | Knowledge Sources | Communication | Viral Diseases | Diseases | Education | Political Factors | Sociocultural Factors | Behavior Document Number: 339895 |
| 10. Title: The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda. Author: Kiggundu V; Watya S; Kigozi G; Serwadda D; Nalugoda F; Buwembo D; Settuba A; Anyokorit M; Nkale J; Kighoma N; Ssempijja V; Wawer M; Gray RH Source: BJU International. 2009 Aug;104(4):529-32. Abstract: OBJECTIVE: To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention. PATIENTS AND METHODS: In a randomized trial, 3011 men were circumcised, using the sleeve method, by six physicians who had completed training, which included 15-20 supervised procedures. The duration of surgery from local anaesthesia to wound closure, moderate or severe surgery-related adverse events (AEs), and wound healing were assessed in relation to the number of procedures done by each physician. RESULTS: The median age of the patients was 24 years. The number of procedures per surgeon was 20-981. The mean time required to complete surgery was approximately 40 min for the first 100 procedures and declined to 25 min for the subsequent 100 circumcisions. After controlling for the number of procedures there was no significant difference in duration of the surgery by patient HIV status or age. The rate of moderate and severe AEs was 8.8% (10/114) for the first 19 unsupervised procedures after training, 4.0% for the next 20-99 (13/328) and 2.0% for the last 100 (P for trend, 0.003). All AEs resolved with management. CONCLUSION: The completion of more than 100 circumcisions was required before newly trained physicians achieved the optimum duration of surgery. AEs were higher immediately after training and additional supervision is needed for at least the first 20 procedures after completing training. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL TRIALS | PHYSICIANS | HIV PREVENTION | MALE CIRCUMCISION | COMPLICATIONS | TRAINING PROGRAMS | SUPERVISION | ANESTHESIA | STANDARDS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Education | Management | Organization and Administration | Treatment | Population Dynamics | Demographic Factors | Population Document Number: 342642 |
| 11. Peer Reviewed Title: The Pediatric AIDS Corps: responding to the African HIV/AIDS health professional resource crisis. Author: Kline MW; Ferris MG; Jones DC; Calles NR; Mizwa MB; Schwarzwald HL Source: Pediatrics. 2009 Jan;123(1):134-6. Abstract: Health professional capacity for delivery of HIV/AIDS care and treatment is severely constrained across sub-Saharan Africa. African health professional expertise in pediatrics is in particularly short supply. Here we describe a Pediatric AIDS Corps program that was designed to place pediatricians and other physicians in Africa on a long-term basis to expand existing health professional capacity for pediatric and family HIV/AIDS care and treatment. In the first 2 years of this program, 76 physicians were placed in 5 African countries that have been hit hard by HIV/AIDS. Enrollment of HIV-infected children in care more than quadrupled over a 24-month period, to 26 590. We believe that this pilot program can serve as a model for larger-scale efforts to immediately expand access for African children and families to life-saving HIV/AIDS care and treatment. Language: English Keywords: AFRICA, SUB SAHARAN | EVALUATION REPORT | RECOMMENDATIONS | PILOT PROJECTS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | PHYSICIANS | HUMAN RESOURCES | CAPACITY BUILDING | HIV INFECTIONS | TREATMENT | PROGRAM DESIGN | TRAINING PROGRAMS | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | Africa | Developing Countries | Evaluation | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Health Personnel | Health | Economic Factors | Program Sustainability | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Education | Program Evaluation Document Number: 328038 |
| 12. Peer Reviewed Title: The effect of interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness on the knowledge and skills of primary health care workers. Author: Kumar D; Aggarwal AK; Kumar R Source: Health Policy and Planning. 2009 Mar;24(2):94-100. Abstract: The conventional 8-day Integrated Management of Neonatal and Childhood Illness (IMNCI) training package poses several operational constraints, particularly due to its long duration. A 5-day training package was developed and administered in an interrupted mode of 3 days and 2 days duration with a break of 4 days in-between, in a district of Haryana state in northern India. Improvement in the knowledge and skills of 50 primary health care workers following the interrupted 5-day training was compared with that of 35 primary health care workers after the conventional 8-day IMNCI training package. The average score increased significantly (P < 0.05) from 46.3 to 74.6 in 8-day training and from 40.0 to 73.2 in 5-day training. Knowledge score improved for all health conditions, like anaemia, diarrhoea, immunization, malnutrition, malaria, meningitis and possible severe bacterial infection, and for breastfeeding in 8-day as well as in 5-day training. Average skills score for respiratory problems increased from 38 to 57 in 8-day training and from 41 to 91 in 5-day training. Corresponding increases in skill scores for diarrhoea assessment were from 28 to 67 and 48 to 75, and for breastfeeding assessment from 33 to 84 and 42 to 86 in 8-day and 5-day training, respectively. Average counselling skill score also rose from 42 to 89 in 8-day and from 37 to 70 in 5-day training. A direct cost saving of US$813 for a batch of 25 trainees and an indirect cost saving of 3 days per trainee and resource person makes the interrupted 5-day IMNCI training more cost-effective. Language: English Keywords: INDIA | RESEARCH REPORT | KAP SURVEYS | COMPARATIVE STUDIES | COST BENEFIT ANALYSIS | HEALTH PERSONNEL | TRAINING PROGRAMS | NEONATAL DISEASES AND ABNORMALITIES | CHILD HEALTH | INTEGRATED PROGRAMS | TIME FACTORS | PRIMARY HEALTH CARE | KNOWLEDGE | EXAMINATIONS AND DIAGNOSES | COST EFFECTIVENESS | Asia, Southern | Asia | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Delivery of Health Care | Health | Education | Diseases | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Health Services | Sociocultural Factors | Medical Procedures | Medicine | Evaluation Indexes Document Number: 331230 |
| 13. Peer Reviewed Title: Early assessment of the implementation of a national programme for the prevention of mother-to-child transmission of HIV in Cameroon and the effects of staff training: a survey in 70 rural health care facilities. Author: Labhardt ND; Manga E; Ndam M; Balo JR; Bischoff A; Stoll B Source: Tropical Medicine and International Health. 2009 Mar;14(3):288-93. Abstract: OBJECTIVES: To assess the availability of equipment and the staff's knowledge to prevent Mother-To-Child Transmission (PMTCT) in rural healthcare facilities recently covered by the national PMTCT programme in Cameroon. METHODS: In eight districts inventories of antiviral drugs and HIV test kits were made on site, using a standardised check-list. Knowledge of HIV and PMTCT was evaluated with a multiple-choice (MC) questionnaire based on typical clinical PMTCT cases. Staff participated subsequently in a 2-day training on HIV/AIDS and the Cameroon PMTCT guidelines. Immediately after training and after 7 months, retention of knowledge was tested with the same questions but in different order and layout. RESULTS: Sixty two peripheral nurse-led clinics and the eight district hospitals were assessed. Whereas all district hospitals presented complete equipment, only six of the peripheral clinics (10%) were equipped with both complete testing materials and a full set of drugs to provide PMTCT. Thirty six peripheral facilities (58%) possessed full equipment for HIV-testing and 8 (13%) stocked all PMTCT drugs. Of 137 nurses, 102 (74%) agreed to the two knowledge tests. Fewer than 66% knew that HIV-diagnosis requires positive results in two different types of rapid tests and only 19% chose the right recommendation on infant-feeding for HIV-positive mothers. Correct answers on drug regimens in different PMTCT settings varied from 25% to 56%. All percentages of correct answers improved greatly with training (P < 0.001) and retention remained high 7 months after training (P < 0.001). CONCLUSIONS: Prevent Mother-To-Child Transmission programmes in settings such as rural Cameroon need to be adapted to the special needs of peripheral nurse-led clinics. Appropriate short training may considerably improve nurses' competence in PMTCT. Other important components are regular supervision and measures to guarantee supply of equipment in rural areas. Language: English Keywords: CAMEROON | EVALUATION REPORT | KAP SURVEYS | HEALTH PERSONNEL | INFANT | GOVERNMENT PROGRAMS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | TRAINING PROGRAMS | RURAL HEALTH SERVICES | KNOWLEDGE | HIV TESTING | ANTIRETROVIRAL DRUGS | EQUIPMENT AND SUPPLIES | PROGRAM EVALUATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Evaluation | Surveys | Sampling Studies | Studies | Research Methodology | Delivery of Health Care | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Programs | Organization and Administration | Disease Transmission Control | Prevention and Control | Diseases | HIV Infections | Viral Diseases | Education | Health Services | Sociocultural Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Treatment Document Number: 330960 |
| 14. Title: [The need for high-quality training and surgical standards for adult male circumcision in China] Author: Li PS; Lu NQ; Cheng Y; Peng YF; Tian L; Liu YD; Ben KL; Xu JC; Lee R; Kim H; Sokal DC Source: Zhonghua Nan Ke Xue. 2009 May;15(5):390-4. Abstract: Although HIV is a significant problem in Africa, HIV infection rates are rising rapidly in other regions such as Asia and South America. International health organizations have recognized the need to develop effective strategies to check the worldwide transmission of HIV. Studies have demonstrated the significant reduction of HIV, HPV, HSV-2 and other STD infection rates with male circumcision (MC). Although numerous MC techniques are available, there are no standardized protocols and surgical training programs. Studies have shown that the standardization of MC techniques coupled with training programs can significantly reduce complication rates. High complication rates have been a primary obstacle to the implementation of MC services. We recommend the establishment of surgical standards and training protocols prior to the promotion of MC services in China. Language: Chinese Keywords: CHINA | RESEARCH REPORT | PREVALENCE | CLIENTS | MEN | MALE CIRCUMCISION | HIV INFECTIONS | TRAINING PROGRAMS | QUALITY OF HEALTH CARE | STANDARDS | HEALTH SERVICES | SURGERY | Asia, Eastern | Asia | Developing Countries | Measurement | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Medical Procedures | Medicine | Delivery of Health Care | Health | Viral Diseases | Diseases | Education | Health Services Evaluation | Program Evaluation | Treatment Document Number: 342636 |
| 15. Title: Improving neonatal caregiving through a developmentally supportive care training program. Author: Liaw JJ; Yang L; Chang LH; Chou HL; Chao SC Source: Applied Nursing Research. 2009 May;22(2):86-93. Abstract: This study was performed to explore the effects of a training program in developmentally supportive care (DSC) on nurse caregiving and preterm infant behavior during bathing in a neonatal unit. The study applied a single-group pretest and posttest design to analyze behaviors. Twenty preterm infants were bathed 120 times by 13 nurses. Indirect observation was adopted to collect all behavioral data. Results showed that infants felt less stress and nurses were more supportive during posttraining baths. Caregivers should receive training in DSC, and its applications could be expanded to other nursing caregiving activities. Language: English Keywords: TAIWAN | RESEARCH REPORT | INFANT | NURSES AND NURSING | BEHAVIOR | CARE AND SUPPORT | TREATMENT | MANAGEMENT | TRAINING PROGRAMS | Asia, Eastern | Asia | Developed Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Health Services | Medical Procedures | Medicine | Organization and Administration | Education Document Number: 342240 |
| 16. Peer Reviewed Title: Provision of anaesthesia services for emergency obstetric care through task shifting in South Asia. Author: Mavalankar D; Sriram V Source: Reproductive Health Matters. 2009 May;17(33):21-31. Abstract: Anaesthesia is required for certain procedures in emergency obstetric care, such as caesarean section and the repair of ruptured uterus. Task shifting for provision of anaesthesia has been implemented in public sector rural hospitals of South Asia in recent years because of significant shortages of anaesthetists, but there has been limited research on this issue. This paper reviews the literature on this topic and documents existing programmes for task shifting anaesthesia services to mid-level providers in South Asia to increase access to emergency obstetric care and reduce maternal mortality. We found that task shifting of anaesthesia services has been effective in expanding coverage and access to care in South Asia, but most programmes have not been implemented systematically as part of an overall human resources strategy. A comprehensive approach, to maximise the benefits of these programmes, calls for countries to appoint a director at national or state level who is responsible for the availability of anaesthesia services in rural areas; legal protections, licensing by a competent authority and registration to perform anaesthesia services, including prescription of anaesthesia drugs; supportive managerial arrangements, competency-based training, monitoring and evaluation; performance rewards, career structure and job clarity; adequate equipment and supplies; support from specialist anaesthetists and quality assurance for safety. Spanish Abstract: La anestesia es necesaria para ciertos procedimientos en los cuidados obstétricos de emergencia, como la cesárea y la histerorrafia. En los últimos años se han cambiado las tareas para el suministro de anestesia en hospitales públicos rurales de Asia meridional debido a la considerable escasez de anestesistas, pero ha habido pocas investigaciones al respecto. En este artículo se revisa el material publicado sobre este tema y se documentan los programas para reasignar las tareas en los servicios de anestesia a los prestadores de servicios de nivel intermedio en Asia meridional, con el fin de ampliar el acceso a los cuidados obstétricos de emergencia y disminuir las tasas de mortalidad materna. Encontramos que al cambiar las tareas de los servicios de anestesia se ha logrado ampliar la cobertura y el acceso a los servicios, pero la mayoría de los programas no han sido implementados sistemáticamente como parte de una estrategia general de recursos humanos. El enfoque integral para maximizar los beneficios de estos programas requiere nombrar a un director, a nivel nacional o estatal, que sea responsable de la disponibilidad de servicios de anestesia en zonas rurales; protecciones jurídicas, permiso de una autoridad competente y registro para proporcionar servicios de anestesia, incluido recetar anestésicos; acuerdos administrativos de apoyo, capacitación basada en la competencia, monitoreo y evaluación; recompensas por el desempeño en el trabajo, estructura profesional y claridad laboral; equipo y suministros adecuados; apoyo de anestesistas especializados y garantía de la calidad para la seguridad. French Abstract: Certains soins obstétricaux d'urgence, comme une césarienne ou la réparation d'une perforation utérine, nécessitent une anesthésie. En raison de la pénurie aiguë d'anesthésistes, des hôpitaux ruraux du secteur public d'Asie du Sud pratiquent la délégation des tâches, mais cela a suscité peu de recherches. Cet article examine les publications sur la question et documente les programmes de délégation des services anesthésiques aux prestataires de niveau intermédiaire en Asie du Sud pour élargir l'accès aux soins obstétricaux d'urgence et réduire la mortalité maternelle. Nous avons constaté que la délégation des services d'anesthésie a permis d'élargir la couverture et l'accès aux soins, mais la plupart des programmes n'ont pas été appliqués systématiquement dans le cadre d'une stratégie globale des ressources humaines. Pour optimiser les avantages de ces programmes, une approche d'ensemble recommande les mesures suivantes aux pays: nomination d'un directeur national ou au niveau de l'État qui sera responsable de la disponibilité des services anesthésiques dans les zones rurales; mesures de protection juridique, enregistrement et autorisation par une autorité compétente de la réalisation des actes d'anesthésie, notamment la prescription d'anesthésiques; dispositions administratives positives, formation, suivi et évaluation fondés sur les compétences; primes à la performance, plans d'avancement et description claire des postes; fournitures et équipements adaptés; soutien des anesthésistes spécialisés et assurance qualité pour la sécurité. Language: English Keywords: ASIA, SOUTHERN | RURAL AREAS | RESEARCH REPORT | LITERATURE REVIEW | PARAMEDICAL PERSONNEL | NURSES AND NURSING | ANESTHESIA | EMERGENCY SERVICES | OBSTETRICS | GOVERNMENT PROGRAMS | PROGRAM ACCESSIBILITY | TRAINING PROGRAMS | HEALTH POLICY | Asia | Developing Countries | Geographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Health Services | Programs | Organization and Administration | Program Evaluation | Education | Policy | Political Factors | Sociocultural Factors Document Number: 342012 |
| 17. Peer Reviewed Title: Maternal health in Gujarat, India: a case study. Author: Mavalankar DV; Vora KS; Ramani KV; Raman P; Sharma B; Upadhyaya M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):235-48. Abstract: Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | MATERNAL HEALTH | MATERNAL HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | OBSTETRICS | EMERGENCY SERVICES | TRANSPORTATION | MATERNAL MORTALITY | BLOOD SUPPLY | HUMAN RESOURCES | TRAINING PROGRAMS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Health | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Management | Organization and Administration | Medicine | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Equipment and Supplies | Medical Procedures | Education Document Number: 341932 |
| 18. Peer Reviewed Title: Public-sector maternal health programmes and services for rural Bangladesh. Author: Mridha MK; Anwar I; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):124-38. Abstract: Achieving Millennium Development Goal 5 in Bangladesh calls for an appreciation of the evolution of maternal healthcare within the national health system to date plus a projection of future needs. This paper assesses the development of maternal health services and policies by reviewing policy and strategy documents since the independence in 1971, with primary focus on rural areas where three-fourths of the total population of Bangladesh reside. Projections of need for facilities and human resources are based on the recommended standards of the World Health Organization (WHO) in 1996 and 2005. Although maternal healthcare services are delivered from for-profit and not-for-profit (NGO) subsectors, this paper is focused on maternal healthcare delivery by public subsector. Maternal healthcare services in the public sector of Bangladesh have been guided by global policies (e.g., Health for All by the Year 2000), national policies (e.g., population and health policy), and plans (e.g., five- or three-yearly). The Ministry of Health and Family Welfare (MoHFW), through its two wings-Health Services and Family Planning-sets policies, develops implementation plans, and provides rural public-health services. Since 1971, the health infrastructure has developed though not in a uniform pattern and despite policy shifts over time. Under the Family Planning wing of the MoHFW, the number of Maternal and Child Welfare Centres has not increased but new services, such as caesarean-section surgery, have been integrated. The Health Services wing of the MoHFW has ensured that all district-level public-health facilities, e.g., district hospitals and medical colleges, can provide comprehensive essential obstetric care (EOC) and have targeted to upgrade 132 of 407 rural Upazila Health Complexes to also provide such services. In 2001, they initiated a programme to train the Government's community workers (Family Welfare Assistants and Female Health Assistants) to provide skilled birthing care in the home. However, these plans have been too meagre, and their implementation is too weak to fulfill expectations in terms of the MDG 5 indicator-increased use of skilled birth attendants, especially for poor rural women. The use of skilled birth attendants, institutional deliveries, and use of caesarean section remain low and are increasing only slowly. All these indicators are substantially lower for those in the lower three socioeconomic quintiles. A wide variation exists in the availability of comprehensive EOC facilities in the public sector among the six divisions of the country. Rajshahi division has more facilities than the WHO 1996 standard (1 comprehensive EOC for 500,000 people) whereas Chittagong and Sylhet divisions have only 64% of their need for comprehensive EOC facilities. The WHO 2005 recommendation (1 comprehensive EOC for 3500 births) suggests that there is a need for nearly five times the existing national number of comprehensive EOC facilities. Based on the WHO standard 2005, it is estimated that 9% of existing doctors and 40% of nurses/midwives were needed just for maternal healthcare in both comprehensive EOC and basic EOC facilities in 2007. While the inability to train and retain skilled professionals in rural areas is the major problem in implementation, the bifurcation of the MoHFW (Health Services and Family Planning wings) has led to duplication in management and staff for service-delivery, inefficiencies as a result of these duplications, and difficulties of coordination at all levels. The Government of Bangladesh needs to functionally integrate the Health Services and Family Planning wings, move towards a facility-based approach to delivery, ensure access to key maternal health services for women in the lower socioeconomic quintiles, consider infrastructure development based on the estimation of facilities using the WHO 1996 recommendation, and undertake a human resource-development plan based on the WHO 2005 recommendation. Language: English Keywords: BANGLADESH | RURAL AREAS | HISTORICAL REVIEW | MATERNAL HEALTH SERVICES | PUBLIC SECTOR | HEALTH POLICY | OBSTETRICS | EMERGENCY SERVICES | NEEDS | COORDINATION | HUMAN RESOURCES | TRAINING PROGRAMS | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Macroeconomic Factors | Economic Factors | Policy | Political Factors | Sociocultural Factors | Medicine | Organization and Administration | Education Document Number: 341938 |
| 19. Title: Evaluation of a Training Program for Counselors in Contraception and Prevention of STIs and a Website-based Support System. Author: Narita S; Tsuru S; Suzuki S; Kudo R; Nonoyama M; Dannoue H; Endo T Source: Studies In Health Technology and Informatics. 2009;146:631-5. Abstract: In Japan, the incidences of pregnancy and sexually transmitted infections (STIs) are increasing among young people. To address these issues, we initiated the following steps: 1) processes supporting contraception and prevention of STIs were created for counseling and construction of an algorithm for that process; 2) a system was developed using a website to support the program for training counselors, and provide practical support during and after the training; and 3) a program for the counselor was developed and is being evaluated. The counseling process was visualized by an algorithm notion method developed by Tsuru et al. Participants registered on the website, enabling them to confirm the lecture contents, record their self studies and submit issues. In order to evaluate this program, a preliminary survey and short tests after the lectures were completed. Participants were nurse-midwives who graduated at a nursing university. 27 participants were expected to complete the program. The answer ratios in the short tests were significantly improved compared to them in the preliminary survey. All participants submitted issues via the website. Further development of the system is planned so that the website can provide practical support by trained counselors and build on the accumulated practical results. Further refinement of the developed algorithm is required so that trained counselors can use it regularly via the website. Language: English Keywords: JAPAN | RESEARCH REPORT | HEALTH PERSONNEL | COUNSELING | EDUCATIONAL ACTIVITIES | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONTRACEPTION | ENTER-EDUCATE | TRAINING ACTIVITIES | TRAINING PROGRAMS | PROGRAM EVALUATION | Asia, Eastern | Asia | Developed Countries | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration | Education | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Family Planning Document Number: 342049 |
| 20. Peer Reviewed Title: Effects of micro-enterprise services on HIV risk behaviour among female sex workers in Kenya's urban slums. Author: Odek WO; Busza J; Morris CN; Cleland J; Ngugi EN; Ferguson AG Source: AIDS and Behavior. 2009 Jun;13(3):449-61. Abstract: This study assessed individual-level effects of adding micro-enterprise services to a peer-mediated HIV/AIDS intervention among 227 female sex workers (FSWs) in Kenya. Survey data were collected in May-July 2003 and July-August 2005. Two-thirds of participants had operational businesses by end-line survey. Nearly half reported to have stopped sex work. Self-reported weekly mean number of all sexual partners changed from 3.26 (SD 2.45) at baseline to 1.84 (SD 2.15) at end-line survey (P < 0.001). Weekly mean number of casual partners did not change significantly. Weekly mean number of regular partners changed from 1.96 (SD 1.86) to 0.73 (SD 0.98) over the follow-up period (P < 0.001). Consistent condom use with regular partners increased by 18.5% and remained above 90% with casual partners. Micro-enterprise services may empower FSWs by giving them an alternative livelihood when they wish to exit or reduce reliance on sex work. Determinants of successful business operation by FSWs deserve further research. Language: English Keywords: KENYA | SLUMS | RESEARCH REPORT | SEX WORKERS | HIV PREVENTION | MICROENTERPRISE DEVELOPMENT | TRAINING PROGRAMS | PROGRAM EVALUATION | RISK REDUCTION BEHAVIOR | SEX BEHAVIOR | CONDOM USE | AGE FACTORS | WOMEN'S EMPOWERMENT | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Behavior | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Education | Population Characteristics | Demographic Factors | Women's Status | Socioeconomic Factors | Economic Factors Document Number: 342112 |
| 21. Peer Reviewed Title: Support for provision of early medical abortion by mid-level providers in Bihar and Jharkhand, India. Author: Patel L; Bennett TA; Halpern CT; Johnston HB; Suchindran CM Source: Reproductive Health Matters. 2009 May;17(33):70-79. Abstract: Medical abortion has the potential to increase the number, cadre and geographic distribution of providers offering safe abortion services in India. This study reports on a sample of family planning providers (263 mid-level providers, 54 obstetrician-gynaecologists and 88 general physicians) from a 2004 survey of health facilities and their staff in Bihar and Jharkhand, India. It identified factors associated with mid-level provider interest in training for early medical abortion provision, and examined whether obstetrician-gynaecologists and general physicians supported non-physicians being trained to provide early medical abortion and what factors influenced their attitudes. Findings demonstrate high levels of mid-level provider interest and reasonable physician support. Among mid-level providers, being male, having a more permissive attitude towards abortion and current provision of abortion using any pharmacological drugs were associated with greater interest in attending training. Mid-level providers based in private health facilities were less likely to show interest. More permissive attitude towards abortion and current medical abortion provision using mifepristone-misoprostol were inversely associated with obstetrician-gynaecologists' support for non-physician provision of medical abortion. General physicians based in private/other health facilities were less supportive than those in public facilities. Study findings strengthen the case for policymakers to expand the pool of cadres that can legally provide safe abortion care in India. Spanish Abstract: Los servicios de aborto con medicamentos tienden a aumentar el número, tipo y distribución geográfica de prestadores de servicios de aborto seguro en la India. Este estudio informa sobre una muestra de proveedores de planificación familiar (263 de nivel intermedio, 54 gineco-obstetras y 88 médicos generales), de una encuesta realizada en 2004 con personal y establecimientos de salud en Bihar y Jharkhand, en la India. Se identificaron los factores asociados con el interés de los profesionales de nivel intermedio en recibir capacitación en la prestación de servicios de aborto con medicamentos temprano, y se examinó si los gineco-obstetras y médicos generales apoyaban la capacitación del personal no médico en estos servicios, así como los factores que influyeron en sus actitudes. Los resultados demuestran altos niveles de interés por parte de los prestadores de nivel intermedio y considerable apoyo de los médicos. Entre los prestadores de nivel intermedio, ser hombre, tener una actitud más permisiva hacia el aborto y proporcionar servicios de aborto con fármacos, se asociaron con mayor interés en la capacitación. Los prestadores de nivel intermedio en establecimientos privados tendían a mostrar menos interés. Las actitudes más permisivas hacia el aborto y la práctica de abortos con mifepristona-misoprostol estaban asociadas inversamente con el apoyo de los gineco-obstetras a la práctica de abortos con medicamentos por personal no médico. Los médicos generales en establecimientos privados brindaron menos apoyo que aquéllos en establecimientos públicos. Estos resultados confirman que los formuladores de políticas deben ampliar el grupo de prestadores de servicios de aborto seguro y legal en la India. French Abstract: L'avortement médicamenteux peut accroître le nombre, le type et la distribution géographique des prestataires de services d'avortement médicalisé en Inde. Cette étude porte sur un échantillon de prestataires de planification familiale (263 cadres moyens, 54 gynécologues-obstétriciens et 88 médecins généralistes) interrogés pour une enquête de 2004 sur les établissements de santé et leur personnel au Bihar et Jharkhand, Inde. Elle a répertorié les facteurs associés avec l'intérêt des cadres moyens pour une formation à l'avortement médicamenteux précoce et a examiné si les gynécologues-obstétriciens et les médecins généralistes soutenaient la formation de non-médecins à ces services et quels facteurs influençaient leurs attitudes. Les conclusions montrent des niveaux élevés d'intérêt de la part des cadres moyens et un soutien raisonnable des médecins. Le fait d'être un homme, d'avoir une attitude plus permissive à l'égard de l'avortement et de pratiquer des avortements pharmaceutiques était associé à un plus grand intérêt des cadres moyens pour la formation. Les cadres moyens basés dans des établissements privés avaient moins de probabilités d'être intéressés. Une attitude plus permissive à l'égard de l'avortement et la pratique d'avortements avec la mifépristone et le misoprostol était inversement associée au soutien que les gynécologues-obstétriciens apportaient à la pratique d'avortements médicamenteux par des non-médecins. Les médecins généralistes basés dans des établissements privés ou autres étaient moins favorables que ceux des centres publics. Les conclusions de l'étude confirment que les décideurs doivent élargir le groupe de prestataires qui peuvent légalement pratiquer des avortements médicalisés en Inde. Language: English Keywords: INDIA | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | FIELD WORKERS | NURSE-MIDWIVES | PARAMEDICAL PERSONNEL | PHYSICIANS | ABORTION | RU-486 | MISOPROSTOL | TRAINING PROGRAMS | ATTITUDES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Data Analysis | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Education | Psychological Factors | Behavior Document Number: 342016 Notification |
| 22. Peer Reviewed Title: Study of blood-transfusion services in Maharashtra and Gujarat States, India. Author: Ramani KV; Mavalankar DV; Govil D Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):259-70. Abstract: Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor. Language: English Keywords: INDIA | EVALUATION REPORT | BLOOD TRANSFUSION | EMERGENCY SERVICES | MATERNAL MORTALITY | BLOOD SUPPLY | SAFETY | HEALTH SERVICES ADMINISTRATION | ORGANIZATION AND ADMINISTRATION | BLOOD DONORS | MONITORING | TRAINING PROGRAMS | Asia, Southern | Asia | Developing Countries | Evaluation | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Equipment and Supplies | Public Health | Management | Education Document Number: 341930 |
| 23. Peer Reviewed Title: A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin. Author: Rowe AK; Onikpo F; Lama M; Osterholt DM; Rowe SY; Deming MS Source: American Journal of Public Health. 2009 May;99(5):837-46. Abstract: OBJECTIVES: We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality. METHODS: We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence. RESULTS: We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P < .05), and both groups outperformed untrained workers. CONCLUSIONS: IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements. Language: English Keywords: BENIN | RESEARCH REPORT | STANDARDS | HEALTH PERSONNEL | PERFORMANCE IMPROVEMENT | HEALTH SERVICES | QUALITY OF HEALTH CARE | CHILD MORTALITY | PREVENTION AND CONTROL | MANAGEMENT | TRAINING PROGRAMS | PROGRAM EVALUATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Delivery of Health Care | Health | Organization and Administration | Health Services Evaluation | Programs | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Education Document Number: 341000 |
| 24. Peer Reviewed Title: Nurse auxiliaries as providers of intrauterine devices for contraception in Guatemala and Honduras. Author: Vernon R Source: Reproductive Health Matters. 2009 May;17(33):51-60. Abstract: Nurse auxiliaries staff the majority of primary health service delivery outlets in low-income countries, particularly in rural areas with high unmet need for contraception. Yet often service delivery guidelines prohibit them from providing contraceptive methods such as the intrauterine device (IUD). Operations research in Guatemala and Honduras in 1997-2005, described in this paper, have shown that nurse auxiliaries can provide IUDs in a safe and clinically appropriate fashion, which can help improve women's choice of methods and decrease costs in health centres with physicians and professional nurses, and health posts. Empowering these health workers requires commitment at the health system and policy levels to a long-term strategy in which small pilot studies are first conducted, followed by phased scaling-up of the strategies, which can require several years. Training can be conducted both in high volume clinics or on-site in health posts. Simple measures such as mentioning the method during counselling and to users of different services and providing women and communities with printed materials have been effective in increasing requests for IUDs. These studies also showed that nurse auxiliaries can take on other reproductive health services, such as contraceptive injections. Language: English Keywords: GUATEMALA | HONDURAS | CRITIQUE | OPERATIONS RESEARCH | PARAMEDICAL PERSONNEL | IUD | INJECTABLES | TRAINING PROGRAMS | NEEDS | COST EFFECTIVENESS | Central America | Latin America | Americas | Developing Countries | Research Methodology | Program Evaluation | Programs | Organization and Administration | Health Personnel | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Education | Economic Factors | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 341668 |
| 25. Peer Reviewed Title: Intervention to train physicians in rural China on HIV/STI knowledge and risk reduction counseling: preliminary findings. Author: Wang D; Operario D; Hong Q; Zhang H; Coates TJ Source: AIDS Care. 2009 Apr;21(4):468-72. Abstract: We evaluated an intervention to train physicians in rural China on knowledge of HIV/STI prevention, diagnosis, treatment options, and HIV/STI behavioral risk reduction counseling. This paper reports preliminary findings related to feasibility and acceptability of the program. Using a pre-post design, 69 physicians were recruited from rural county hospitals and participated in a 10-day group training program, followed by two months of clinical fieldwork and two additional weeks of training. Physicians completed baseline and six-month assessments. Patients' cohorts, recruited from clinic waiting areas of participating physicians, completed baseline and six-month HIV/STI risk assessments. Physicians reported increased knowledge of HIV biology and pathology, epidemiology, host immune response, opportunisitic infection and syndromic management, antiretroviral therapy, risk reduction counseling, and stigma reduction following the training. Patients reported improved knowledge of HIV, reduced HIV stigma, higher rates of HIV testing, and improved condom use at follow-up. The findings suggest that training physicians on HIV/STI-related knowledge and risk reduction counseling is a promising strategy for reducing HIV/STI epidemics in rural China. Language: English Keywords: CHINA | RURAL AREAS | EVALUATION REPORT | PROVIDERS WITH CLIENTS | PHYSICIANS | TRAINING PROGRAMS | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | KNOWLEDGE | RISK REDUCTION BEHAVIOR | COUNSELING | PROGRAM ACCEPTABILITY | Asia, Eastern | Asia | Developing Countries | Geographic Factors | Population | Evaluation | Health Services | Delivery of Health Care | Health | Health Personnel | Education | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Sociocultural Factors | Behavior | Clinic Activities | Program Activities | Programs | Organization and Administration | Program Evaluation Document Number: 341835 |
| 26. Title: It Works! Communication for HIV prevention and social change in adolescents: a mid-term review. Author: Watson C; Walugembe P; Namubiru E; Kato I; Barton T Source: Kampala, Uganda, Straight Talk Foundation, 2009 Feb. 80 p. Abstract: This report is a mid-term review of the Straight Talk Foundation’s work on improving the sexual and reproductive health of adolescents in Uganda. It is primarily a qualitative assessment of progress made toward meeting the program’s objectives and is informative for colleagues implementing similar programs in other contexts. Language: English Keywords: UGANDA | SUMMARY REPORT | CASE STUDIES | ADOLESCENTS | PARENTS | RADIO PROGRAM | CHILD MARRIAGE | CURRENTLY MARRIED | COMMUNICATION PROGRAMS | TRAINING PROGRAMS | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Radio | Broadcast Media | Mass Media | Communication | Marriage Patterns | Marriage | Nuptiality | Marital Status | Education | Programs | Organization and Administration Document Number: 331825 |
| 27. Title: 'Not only a teacher, but an ambassador': Facilitating HIV/AIDS educators to take action. Author: Wood LA Source: African Journal of AIDS Research. 2009 Apr;8(1):83-92. Abstract: This article describes how South African educators were facilitated to adopt the role of HIV/AIDS 'ambassadors' within their circles of influence by participating in a two-year course for an Advanced Certificate in Education for HIV/AIDS in Teaching (ACE-HAT) qualification. It reports on the data generated by a qualitative study of the teachers' experiences with and subsequent to the programme. The programme works from the assumption that the HIV pandemic has provided us with an opportunity to address many of the issues and inequalities that the education system is facing today. Based on the Freirian notion of liberation pedagogy, the article puts forward the argument that by adopting a holistic and critical approach to HIV/AIDS education, educators are able to move beyond the traditional responsibilities of the teacher, and thus play an important role as agents of change in their school and community. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | QUALITATIVE RESEARCH | TEACHERS | HIV PREVENTION | AIDS PREVENTION | HEALTH EDUCATION | TRAINING PROGRAMS | CURRICULUM | ATTITUDES | KNOWLEDGE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Education | HIV Infections | Viral Diseases | Diseases | AIDS | Psychological Factors | Behavior | Sociocultural Factors Document Number: 341290 |
| 28. Peer Reviewed Title: Non-physician clinicians can safely provide first trimester medical abortion. Author: Yarnall J; Swica Y; Winikoff B Source: Reproductive Health Matters. 2009 May;17(33):61-69. Abstract: Mid-level clinicians are integral to provision of pregnancy-related care in many settings. Yet midwives and other non-physician clinicians are excluded from training and from providing medical abortion. A substantial body of evidence exists demonstrating that mid-level providers, including nurses and midwives specialized in pregnancy-related care for women, are either already competently involved in providing medical abortions or have the requisite skills to expand their scope of practice to include medical abortion with a short course of additional training. While additional evidence may be needed to show that second trimester medical abortion can be safely and effectively provided by trained mid-level providers, we argue that for first trimester medical abortion the evidence is sufficient for governments to implement, monitor and evaluate programmes that allow mid-level clinicians to offer first trimester medical abortion independently. Because mid-level clinicians often work in rural or remote areas where physicians are scarce or where there are few surgical facilities or equipment, the expansion of the medical abortion provider pool has the potential to greatly improve the reproductive health of women worldwide. Spanish Abstract: En muchos lugares, el personal médico de nivel intermedio es fundamental en la atención relacionada con el embarazo. No obstante, las parteras profesionales y otros profesionales de la salud no médicos son excluidos de recibir capacitación y proporcionar servicios de aborto con medicamentos. Existe un considerable conjunto de pruebas que demuestran que los prestadores de servicios de nivel intermedio, como las enfermeras y parteras profesionales especializadas en la atención del embarazo, ya participan competentemente en efectuar procedimientos de aborto con medicamentos o cuentan con las habilidades necesarias para realizar abortos con medicamentos si atienden un curso corto de capacitación adicional. Aunque se necesitan más pruebas para demostrar que los profesionales de nivel intermedio capacitados pueden efectuar procedimientos de aborto con medicamentos en el segundo trimestre de manera segura y eficaz, argüimos que para el primer trimestre existe suficiente evidencia para que los gobiernos establezcan, monitoreen y evalúen programas que permitan que los profesionales de la salud de nivel intermedio ofrezcan servicios de aborto con medicamentos de primer trimestre independientemente. Dado que estos profesionales suelen trabajar en zonas rurales o remotas donde los médicos son escasos o donde existen pocos centros o equipos quirúrgicos, al ampliarse el grupo de prestadores de servicios de aborto con medicamentos se podría mejorar notablemente la salud reproductiva de las mujeres del mundo. French Abstract: Les cliniciens de niveau intermédiaire font souvent partie intégrante des soins liés à la grossesse. Pourtant, les sages-femmes et autres cliniciens non médecins sont exclus de la formation et de la pratique de l'avortement médicamenteux. Or, une somme considérable de données montre que les prestataires de niveau intermédiaire, notamment les infirmières et les sages-femmes spécialisées dans les soins liés à la grossesse, sont déjà engagés avec compétence dans les avortements médicamenteux ou possèdent les aptitudes requises pour élargir leur pratique et y inclure l'avortement médicamenteux après une brève formation complémentaire. Si des recherches supplémentaires seront peut-être nécessaires pour montrer que les prestataires de niveau intermédiaire peuvent pratiquer efficacement et en toute sécurité l'avortement médicamenteux du deuxième trimestre, nous estimons qu'il existe suffisamment de preuves pour que les gouvernements appliquent, surveillent et évaluent des programmes qui autoriseront les cliniciens de niveau intermédiaire à proposer de manière indépendante des avortements médicamenteux du premier trimestre. Comme ces cliniciens travaillent souvent dans des zones rurales ou éloignées, où les médecins sont rares ou qui disposent de peu de centres ou d'équipements chirurgicaux, l'expansion du corps de prestataires de l'avortement médicamenteux peut améliorer sensiblement la santé génésique des femmes dans le monde. Language: English Keywords: GLOBAL | CRITIQUE | MIDWIVES AND MIDWIFERY | NURSE-MIDWIVES | PARAMEDICAL PERSONNEL | ABORTION | PREGNANCY, FIRST TRIMESTER | SAFETY | TRAINING PROGRAMS | GESTATIONAL AGE | HEALTH POLICY | LEGISLATION | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Public Health | Education | Fetus | Policy | Political Factors | Sociocultural Factors Document Number: 342015 Notification |
| 29. Title: Improving provision of the IUD. Author: Family Health International [FHI] Source: Research Triangle Park, North Carolina, FHI, 2008. [2] p. (FHI Briefs: Menu of PracticesUSAID Cooperative Agreement No. GPO-A-00-05-00022-0) Abstract: Intrauterine devices (IUDs) are the most popular reversible contraceptive method worldwide, yet access to and use of IUDs is low or in decline in many countries, particularly in Africa. Increasing access to high-quality IUD services will ensure that women can choose from a balanced mix of contraceptive methods and fulfill their reproductive intentions. The IUD is an extremely safe, effective, and low-cost method and provides women -- especially those seeking an alternative to hormonal contraception -- with an important option. Language: English Keywords: GLOBAL | RECOMMENDATIONS | WOMEN | CLIENTS | PERSONS LIVING WITH HIV/AIDS | IUD | SCREENING | HIV PREVENTION | TRAINING PROGRAMS | REPRODUCTIVE HEALTH | HEALTH SERVICES | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Contraceptive Methods | Contraception | Family Planning | Examinations and Diagnoses | Medical Procedures | Medicine | Delivery of Health Care | Health | Education Document Number: 331524 |
| 30. Title: Training program aimed at on-site supervisors can improve quality of care. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, [2008]. [2] p. (Research Briefs on Family Planning Service Delivery) Abstract: An intervention to train on-site, in-charge reproductive health supervisors significantly improved the quality of care at the levels of supervisors, providers, and client-provider interactions. The USAID-sponsored study evaluated JHPIEGO's "supportive supervision" training package - called Performance Quality Improvement - at 60 health facilities in Kenya. At the end of the intervention, data were collected to evaluate the supervisors' techniques and knowledge. When compared with supervisors who were not trained, those who were trained were more knowledgeable of techniques for assessing provider performance, motivating staff, and communicating expectations to staff. Supervisors in the training group were also more likely to observe provider-client interactions and to give feedback to the providers regarding these interactions. Providers in the training group improved in their communication with clients, infection-prevention practices, and attention to standards of confidentiality. All of these changes were statistically significant. Changes in client satisfaction, while promising, did not prove statistically significant. Additional studies with larger sample sizes and different measures of the clients' experience may help to evaluate this dimension further. The techniques used to train supervisors in this study were not specific to the provision of reproductive health services. Therefore, this kind of intervention could also be useful to other types and levels of health care supervisors. The training program cost US $2,113 per supervisor trained, but could be less costly if implemented locally. (Full text) Language: English Keywords: KENYA | SUMMARY REPORT | SUPERVISION | TRAINING PROGRAMS | PROGRAM EFFECTIVENESS | REPRODUCTIVE HEALTH | QUALITY OF HEALTH CARE | PERFORMANCE IMPROVEMENT | INTERPERSONAL COMMUNICATION | CONFIDENTIAL INFORMATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Management | Organization and Administration | Education | Program Evaluation | Programs | Health | Health Services Evaluation | Communication | Ethics | Sociocultural Factors Document Number: 331701 |
 |
||
 |
Information & Knowledge for Optimal Health (INFO) Project 111 Market Place Suite 310, Baltimore, MD 21202 Phone: 410-659-6300 Fax: 410-659-6266 Security & Privacy Policy |  |